Nursing Sensitive Quality Indicator Data Collection Checklist
Systematic collection of nursing-sensitive quality indicators for benchmarking and quality improvement.
- Industry: Healthcare
- Frequency: Monthly/Quarterly
- Estimated Time: 30-45 minutes
- Role: Quality/Nursing Leadership
- Total Items: 32
- Compliance: NDNQI, ANA National Database, CMS Quality Measures
Patient Falls
Fall data
- Total falls documented?
- Falls with injury documented?
- Patient days calculated?
Pressure Injuries
HAPU data
- HAPU count documented?
- Prevalence survey completed?
Healthcare-Associated Infections
Infection data
- CAUTI data collected?
- CLABSI data collected?
- Device days documented?
Restraint Use
Restraint data
- Restraint prevalence documented?
- Restraint-related injuries documented?
Pre-Assessment Information
Initial assessment documentation and patient/facility identification
- Assessor Name / Credentials
- Assessment Date
- Department / Unit
- Assessment Type (Routine/Annual/Complaint)
- Previous assessment findings reviewed?
Infection Prevention & Control
Verify infection control practices per CDC and Joint Commission standards
- Hand hygiene compliance observed?
- Appropriate PPE available and properly used?
- Isolation precautions properly implemented?
- Sharps containers available and not overfilled?
- High-touch surfaces properly disinfected?
Patient Safety & Identification
Verify patient safety protocols and identification procedures
- Two patient identifiers used before procedures?
- Fall risk assessment completed?
- Call light within patient reach?
- Bed in lowest position with brakes locked?
Medication Safety & Management
Verify medication handling and administration practices
- Medications stored securely and at proper temperature?
- Controlled substances properly secured and counted?
- No expired medications in stock?
- High-alert medications properly labeled?
Environment of Care & Safety
Verify facility environment meets safety standards
- Fire exits clear and unobstructed?
- Emergency equipment functional and accessible?
- Spill kits available and stocked?
- Electrical cords and outlets in safe condition?
Related Healthcare Checklists
- Quality Improvement Project Plan Checklist
- Clinical Documentation Improvement Checklist
- Nursing Competency Verification Checklist
- Nursing Peer Review Checklist
- Interpreter Services Documentation Checklist
- Modified Early Warning Score (MEWS) Assessment Checklist
- Blood Glucose Monitoring Protocol Checklist
- Medical Staff Credentialing Verification Checklist