Indicators of effectiveness of nursing care in the dimension of patient safety

quantitative survey, using the electronic Delphi sampli, with 52 participants selected by the Snowball sampling. Eight indicators were evaluated regarding the attributes: availability, reliability, simplicity, representativeness, sensitivity, comprehensiveness, objectivity, cost, utility, stability and timeliness. For validation, the minimum agreement criterion was 70%.

Results:

Cronbach’s alpha (0.942) evidenced the high internal consistency among the attributes. The indicators fall with damage, hip fracture, and postoperative hip fracture, incidents related to equipment, incidents due to failures in patient identification, and pressure injury were validated in all attributes, and those of medication error and hand Hygiene were not validated.

Conclusions:

the validated indicators allow assessment of the effectiveness of hospital nursing care. Unavailability of data is an obstacle to monitoring patient safety.

Descriptors:
Quality Indicators, Health Care; Effectiveness; Nursing Care; Patient Safety; Quality Management

Attribute	Specification
Availability	Easy obtainment of data for its structuring.
Reliability	Original sources and reliable data collection and processing methods.
Simplicity	Easy estimative from basic information, understanding or interpretation.
Representativeness	It faithfully represents what it proposes to measure.
Sensitivity	It distinguishes occasional variations in the trend of situation, in a given area, with reflections on its result.
Scope	It synthesizes as many conditions or factors as possible that affect the situation to be measured.
Objectivity	Clarity in measuring objective.
Low cost	Favorable relationship between costs of obtaining data and benefits arising from its use.
Utility	Provides decision-making.
Stability	The measurement series allows for consistent monitoring and comparisons.
Timeliness	Structured with current and timely information to use.

Indicators	Agreement rates of experts ' responses regarding the correspondence of indicators to the attributes surveyed	Validation
Incidents due to patient identification failures	Timeliness (88.47%); objectivity and usefulness (88.46%); Other attributes above 75%	Yes
Pressure injury	Timeliness (98.09%); usefulness (98.08%); objectivity and representativeness (96.15%); Other attributes above 82.69%	Yes
Hip fracture in hospitalized patients	Simplicity regarding the ease of calculation (90.38%); Simplicity in the interpretation of the indicator (88.46%); objectivity (88.46%); Other attributes above 73.07%	Yes
Hip fracture postoperatively	Simplicity related to the ease of estimative (75.00%); stability and sensitivity (74.74%); Other attributes above 70.59%	Yes
Falls with damage	Usefulness and stability (94.23%); Simplicity regarding the ease to estimate (92.31%); simplicity in understanding (92.16%); Other attributes above 76.92%	Yes
Serious equipment- related incidents	Timeliness (82.64%); objectivity and usefulness (78.85%); Other attributes above 78.84%	Yes
Multimodal hand hygiene strategy	Usefulness (92.31%); representativeness and timeliness (82.70%); stability (80.77%); availability (53.68%); Other attributes above 71.58%	No
Medication error.	Objectivity (90.40%); usefulness (88.46%); availability (67.37%); other attributes above 74.74%	No

Indicators	Comments and Suggestions
Multimodal hand hygiene strategy	Comments: Techniques for obtaining data require time (P02, P51); it s difficult to execute (P06, P31, P16); measuring missed opportunities requires specific surveillance (P06, P31).
Multimodal hand hygiene strategy	Suggestions: studying different ways of collecting lost opportunities for hand cleaning (P44); Help of multimers - sectors audited with checklist (P30); Using of sampling stratified by sectors and professionals, non-identifiable observers, registering professionals behavior(P17).
Medication error.	Comments: This type of error is difficult to detect when it does not cause damage, (P16, P17, P32, P36).
Medication error.	Suggestions (to improve detection): Improvement of notes in medical records and reports of pharmacy production (P45); Computerization of medical records, management, logistics and medication administration (P08, P37, P48, P51); Institutional stimulus to increase incident notifications (P10, P16, P27, P35); especially near-miss and undamaged incidents (P10, P35, P45); patient inclusion(P08); perform pharmaceutical technical analysis of prescriptions (P26, P33).

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Leila Soares Seiffert. E-mail: leilaseiffert@gmail.com