Hello! I’m Nolly, and in this session, I will explore Nursing-Sensitive Quality Indicators (NSQIs), highlighting essential metrics in nursing practice that directly affect patient outcomes. This overview focuses on the concept of NSQIs, their importance in health care, and the integral role nurses play in collecting and reporting related data.

Introduction: Understanding Nursing-Sensitive Quality Indicators

The National Database of Nursing-Sensitive Quality Indicators (NDNQI), created by the American Nurses Association (ANA), gathers comprehensive data from hospitals across the U.S. to assess the quality of nursing care (Montalvo, 2020). This national tool enables healthcare providers to benchmark their performance and identify improvement opportunities. NSQIs evaluate aspects of care that are influenced by nursing actions, focusing on care structure, processes, and patient outcomes (Press Ganey, 2024). These metrics encompass areas such as pressure injuries, staffing levels, infection rates, and falls.

This guide centers on “Patient Falls with Injury” (PFI), an indicator that tracks both the frequency of patient falls and whether these events result in injury. PFI is a critical metric since falls are one of the most preventable and harmful incidents in hospital settings. According to the CDC (2024), over 14 million adults aged 65 or older experience falls annually, resulting in approximately 9 million injuries. These incidents often extend hospital stays, increase costs, and in severe cases, lead to permanent disability or death. As a reflection of nursing vigilance and safety practices, the PFI indicator supports the need for enhanced monitoring systems and safer care environments (Oner et al., 2020).

For novice nurses, understanding and applying fall prevention measures is crucial. Awareness of risk factors and proactive strategies—such as using assistive devices, educating patients, and conducting frequent assessments—can significantly reduce falls. Mastery of these skills supports a culture of safety and accountability within nursing practice (Li & Surineni, 2024).

Gathering and Reporting Nursing-Sensitive Data

Data related to PFIs is usually collected through multiple sources, including electronic health records (EHRs), incident reports, and direct staff observation. Nurses are typically responsible for documenting fall incidents immediately, including time, location, severity, injuries, and interventions. This data is entered into centralized systems that feed into hospital-wide quality databases (Krakau et al., 2021).

Falls are often categorized based on injury severity to aid in identifying patterns and root causes. Quality assurance teams validate data through chart audits, and routine reports are created and shared with administrative and clinical teams. These reports may feature trend graphs and comparison charts presented via dashboards and discussed during staff meetings to promote transparency and continuous quality enhancement (AHRQ, 2025).

Nurses contribute significantly to this process through consistent and accurate reporting. They play a pivotal role by employing fall prevention measures such as hourly rounding, use of bed alarms, and mobility support. Failing to document these interventions accurately can misrepresent the effectiveness of safety strategies. As a result, nursing documentation directly influences the reliability of quality data and subsequent improvements in patient safety (Takase, 2022; Li & Surineni, 2024).

Interdisciplinary Collaboration in Quality Indicator Management

The accurate reporting and reduction of PFIs depend on collaboration across various disciplines, including nurses, physicians, therapists, IT staff, and quality improvement teams. Each member plays a vital role: nurses identify and report falls, physicians manage injuries, and therapists evaluate mobility needs. Risk managers and quality teams analyze trends, create reports, and revise policies in collaboration with clinical staff (Krakau et al., 2021; AHRQ, 2025).

Information technology specialists support this ecosystem by enhancing EHR systems and real-time dashboards. Together, the team examines systemic causes—like low staffing or environmental hazards—and designs safer workflows. This team-based approach fosters an environment where reliable data collection and shared accountability drive targeted fall prevention strategies.

Administrative Role in Quality Improvement

Leadership uses NSQI data like PFI to assess organizational performance and implement targeted improvements. For instance, an increase in nighttime falls may prompt leadership to adjust staffing or improve lighting conditions (Woltsche et al., 2022). These data points also shape evidence-based nursing practices by informing standardized care protocols.

Policies such as mandatory fall risk assessments upon admission, regular hourly rounding, and the use of assistive devices are often supported by EHR alerts and training programs. These measures contribute to safer hospital environments, reduce fall rates, and enhance recovery outcomes (Takase, 2022; Oner et al., 2020).

Evidence-Based Practice Guidelines for Patient Safety

The PFI indicator plays a foundational role in the development of evidence-based practices (EBPs) that promote patient safety. Fall data are analyzed to identify patterns and risk profiles, which in turn guide intervention strategies. A widely used tool is the Morse Fall Scale, which allows nurses to assess fall risk upon admission and daily thereafter (Mao et al., 2024). Based on patient scores, EHR systems trigger appropriate interventions such as bed alarms or sensor-equipped footwear.

Visual alerts like colored wristbands are also common EBP strategies. These indicators help staff easily identify at-risk patients and adjust care accordingly. For instance, high-risk patients may receive increased supervision or assistance during mobility activities. These practices enhance nurse responsiveness and contribute to lower fall rates and shorter hospital stays (Boot et al., 2023).

Summary Table: Key Concepts of Nursing-Sensitive Quality Indicators

Section	Key Concepts	Examples/Tools
Definition of NSQIs	Metrics affected by nursing practice; assess structure, process, and outcomes	Pressure ulcers, falls, infection rates
Focus Indicator	Patient Falls with Injury (PFI) – measures fall frequency and severity	Injuries from falls, such as fractures or head trauma
Data Collection	Recorded via EHRs, incident reports, and direct observation	Fall logs, incident forms
Reporting Mechanisms	Dashboards, scorecards, and trend analyses shared with teams and leadership	Internal portals, quality improvement reports
Nursing Role	Preventive care, documentation, and interventions	Bed alarms, non-slip socks, hourly rounding
Interdisciplinary Collaboration	Coordinated efforts among nurses, physicians, therapists, and IT staff	Trend reviews, shared policy updates
Administrative Impact	NSQIs guide staffing, training, and environmental improvements	Adjustments in night shift staffing, lighting enhancements
Evidence-Based Practices	Risk assessment tools and visual alerts improve patient safety	Morse Fall Scale, colored wristbands

Conclusion

Patient Falls with Injury (PFI) serves as a vital nursing-sensitive quality indicator reflecting the safety and effectiveness of nursing care. By monitoring and acting on NSQI data, healthcare facilities can implement evidence-based practices that improve patient safety, reduce complications, and support nursing excellence. Nurses, as frontline caregivers, are instrumental in this effort through meticulous documentation and proactive intervention strategies.

References

AHRQ. (2025). Falls dashboard. Ahrq.gov. https://www.ahrq.gov/npsd/data/dashboard/falls.html

Boot, M., Allison, J., Maguire, J., & O’Driscoll, G. (2023). QI initiative to reduce the number of inpatient falls in an acute hospital trust. BMJ Open Quality, 12(1), e002102. https://doi.org/10.1136/bmjoq-2022-002102

Centers for Disease Control and Prevention. (2024). Older adult falls data. Cdc.gov. https://www.cdc.gov/falls/data-research/index.html

Krakau, K., Andersson, H., Dahlin, Å. F., Egberg, L., Sterner, E., & Unbeck, M. (2021). Validation of nursing documentation regarding in-hospital falls: A cohort study. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00577-4

Li, S., & Surineni, K. (2024). Falls in hospitalized patients and preventive strategies: A narrative review. The American Journal of Geriatric Psychiatry: Open Science, Education, and Practice, 5, 1–9. https://doi.org/10.1016/j.osep.2024.10.004

Mao, B., Jiang, H., Chen, Y., Wang, C., Liu, L., Gu, H., Shen, Y., & Zhou, P. (2024). Re-evaluating the Morse Fall Scale in obstetrics and gynecology wards and determining optimal cut-off scores for enhanced risk assessment: A retrospective survey. PLOS ONE, 19(9). https://doi.org/10.1371/journal.pone.0305735

Montalvo, I. (2020, September 30). The national database of nursing quality indicators. OJIN: The Online Journal of Issues in Nursing, 12(3). https://ojin.nursingworld.org/table-of-contents/volume-12-2007/number-3-september-2007/nursing-quality-indicators/