Reliability and Validity of the NDNQI® Injury Falls Measure

Abstract

Although remarkable efforts have been made to improve patient fall reporting through the utilization of standardized definitions, injury falls reporting has rarely been examined. This study used an overall intra-class correlation coefficient (ICC) estimate and factor analysis to assess the reliability and validity of the National Database of Nursing Quality Indicators® (NDNQI®) falls with injury measure. Data were collected from an online Fall Injury Level Survey that was administered to 1,159 NDNQI site coordinators (39.7% response rate; 91% registered nurses [RNs]). Estimated overall ICC was .85. Exploratory factor analysis (EFA) with a Promax rotation (root mean square error of approximation [RMSEA] = 0.053) identified three latent factors: No Injury, Minor Injury, and Moderate/Major Injuries. Final confirmatory factor analysis (CFA) assessment (comparative fit index [CFI] = 0.914, Tucker Lewis Index [TLI] = 0.910, RMSEA = 0.048) confirmed an acceptable model fit. Results provided strong evidence that the NDNQI falls with injury measure is reliable and valid in supporting hospitals’ fall prevention efforts and future injurious falls research.

Keywords

injury falls fall injury levels reliability NDNQI

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References

Bergquist-Beringer

Davidson

Agosto

Linde

N. K.

Abel

Spurling

Christopher

(2009). Evaluation of the National Database of Nursing Quality Indicators (NDNQI) training program on pressure ulcers. Journal of Continuing Education in Nursing, 40, 252-258; quiz 259-260, 279.

Bergquist-Beringer

Gajewski

Dunton

Klaus

(2011). The reliability of the National Database of Nursing Quality Indicators pressure ulcer indicator: A triangulation approach. Journal of Nursing Care Quality, 26, 292-301. doi:10.1097/NCQ.0b013e3182169452

Bordens

Abbott

B. B.

(2011). Research design and methods: A process approach (8th ed.). New York, NY: McGraw-Hill Higher Education.

Centers for Disease Control and Prevention. (2013). Costs of falls among older adults. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html

Centers for Medicare & Medicaid Services. (2012). Hospital-acquired conditions (HAC) in acute inpatient prospective payment system (IPPS) hospitals. Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcq-Cond/Downloads/HACFactsheet.pdf

Currie

(2008). Fall and injury prevention. In Hughes

R. G.

(Ed.), Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/nurseshdbk.pdf

Englander

Hodson

T. J.

Terregrossa

R. A.

(1996). Economic dimensions of slip and fall injuries. Journal of Forensic Sciences, 41, 733-746.

Gajewski

B. J.

Hart

Bergquist-Beringer

Dunton

(2007). Inter-rater reliability of pressure ulcer staging: Ordinal probit Bayesian hierarchical model that allows for uncertain rater response. Statistics in Medicine, 26, 4602-4618. doi:10.1002/Sim.2877

Hart

Bergquist

Gajewski

Dunton

(2006). Reliability testing of the National Database of Nursing Quality Indicators pressure ulcer indicator. Journal of Nursing Care Quality, 21, 256-265.

10.

Inouye

S. K.

Brown

C. J.

Tinetti

M. E.

(2009). Medicare nonpayment, hospital falls, and unintended consequences. New England Journal of Medicine, 360, 2390-2393. doi:10.1056/NEJMp0900963

11.

Kline

R. B.

(2011). Principles and practice of structural equation modeling (3rd ed.). New York, NY: Guilford Press.

12.

Lake

E. T.

Shang

Klaus

Dunton

N. E.

(2010). Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in Nursing & Health, 33, 413-425. doi:10.1002/nur.20399

13.

MacCallum

R. C.

Roznowski

Necowitz

L. B.

(1992). Model modifications in covariance structure analysis: The problem of capitalization on chance. Psychological Bulletin, 111, 490-504.

14.

Mion

L. C.

Chandler

A. M.

Waters

T. M.

Dietrich

M. S.

Kessler

L. A.

Miller

S. T.

Shorr

R. I.

(2012). Is it possible to identify risks for injurious falls in hospitalized patients? Joint Commission Journal on Quality and Patient Safety, 38, 408-413.

15.

Montalvo

(2007). The National Database of Nursing Quality Indicators (NDNQI®). The Online Journal of Issues in Nursing, 12(3). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingQualityIndicators.aspx?%3E

16.

Muthén

L. K.

Muthén

B. O.

(1998-2009). Mplus user’s guide (5th ed.). Los Angeles, CA: Author.

17.

National Database of Nursing Quality Indicators. (2010). Guidelines for data collection on the American Nurses Association’s National Quality Forum endorsed measures. Kansas City: University of Kansas Medical Center.

18.

National Priorities Partnership. (2011). Input to the Secretary of Health and Human Services on priorities for the national quality strategy. Washington, DC: National Quality Forum. Retrieved from http://www.qualityforum.org/WorkArea/linkit.aspx?ItemID=68238

19.

National Quality Forum. (2002). A national framework for healthcare quality measurement and reporting: A consensus report. Retrieved from http://www.qualityforum.org/Publications/2002/07/A_National_Framework_for_Healthcare_Quality_Measurement_and_Reporting.aspx

20.

National Quality Forum. (2004). National voluntary consensus standards for nursing-sensitive care: An initial performance measure set. Retrieved from http://www.qualityforum.org/Publications/2004/10/National_Voluntary_Consensus_Standards_for_Nursing-Sensitive_Care__An_Initial_Performance_Measure_Set.aspx

21.

National Quality Forum. (2011). Serious reportable events in healthcare—2011 update: A consensus report. Retrieved from http://www.qualityforum.org/Publications/2011/12/Serious_Reportable_Events_in_Healthcare_2011.aspx

22.

National Quality Forum. (2013a). Falls with injury. Retrieved from http://www.qualityforum.org/QPS/0202

23.

National Quality Forum. (2013b). Patient fall rate. Retrieved from http://www.qualityforum.org/QPS/0141

24.

Schwenk

Lauenroth

Stock

Moreno

R. R.

Oster

McHugh

. . . Hauer

(2012). Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: A systematic review. BMC Medical Research Methodology, 12, Article 50. doi:10.1186/1471-2288-12-50

25.

Shorr

R. I.

Mion

L. C.

Chandler

A. M.

Rosenblatt

L. C.

Lynch

Kessler

L. A.

(2008). Improving the capture of fall events in hospitals: Combining a service for evaluating inpatient falls with an incident report system. Journal of the American Geriatrics Society, 56, 701-704.

26.

Simon

Klaus

Gajewski

B. J.

Dunton

(2013). Agreement of fall classifications among staff in US hospitals. Nursing Research, 62, 74-81.

27.

Skrondal

Rabe-Hesketh

(2004). Generalized latent variable modeling: Multilevel, longitudinal, and structural equation models. Boca Raton, FL: CRC Press.