Quality indicators of hospital nursing care

Objective: To introduce the use of a balanced scorecard for the management and follow-up of quality objectives in nursing care. Material and methods: Specific information systems were established: nursing records and the results of an audit for the follow-up of quality objectives in nursing care were computerized. An optimal set of indicators was determined. Procedures for expressing indicator values were designed. Results: The information system of the nursing quality unit currently consists of five databases which, after 3 years of activity, manage the records of 690 nurses interviewed during the audits and of 6020 patients. A panel of 42 indicators was identified. These indicators were classified into eight groups corresponding to evaluation of nursing (n = 4), nursing care plans (n = 4), nursing discharge reports (n = 9), pressure ulcers (n = 8), inpatient falls (n = 3), urinary catheterization (n = 5), nurses' knowledge of protocols (n = 6), and patients' opinions (n = 3). Conclusion: Three years is too short a period to analyze changes in indicators but is long enough to determine the stability of those that are subject to conventional follow-up and to demonstrate improvement, which was considerable in the nursing staff's knowledge of protocols and appreciable in the use of records. Because the indicators are not uniformly distributed among the different nursing units, the hospital's interpretation of some indicators, especially those in the introduction phase, can be distorted.