Implementation Guide for the Nursing Management Minimum Data Set: NMMDS© October 2015 Sponsored by: Center for Nursing Informatics School of Nursing – University of Minnesota
Content INTRODUCTION ... 3 Background ... 3 Purpose ... 4 Audience... 4 Contributors ... 5 Scope ... 6
Use Case Scenario ... 6
SPECIFICATION OVERVIEW ... 8
Organization of this Specification ... 8
Convention used in this Implementation Guide ... 9
Use of Vocabulary Standards ... 10
NURSING MANAGEMENT MINIMUM DATA SET – NMMDS ... 11
Environment ... 11
Nurse Resources ... 11
COMPONENT - ENVIRONMENT ... 12
01 Facility Unique Identifiers ... 12
02 Type of Nursing Delivery Unit/Service ... 13
03 Patient/Client Population... 25
04 Volume of Nursing Delivery Unit/Service... 28
05 Care Delivery Structure and Outcomes ... 35
06 Patient/Client Accessibility ... 36
10 Accreditation/Certification/Licensure ... 39
COMPONENT - NURSE RESOURCES ... 41
13 Staffing ... 41
14 Satisfaction ... 48
19 Nurse Demographics per Unit or Service ... 50
20 Clinical Mental work ... 59
21 Environmental Conditions... 65
22 Electronic Health Record (EHR) Implementation Stages ... 67
REFERENCES ... 70
APPENDIX A – The Nursing Management Minimum Data Set Survey ... 75
INTRODUCTION Background
The Nursing Management Minimum Data Set (NMMDS) is a minimum collection of core variables needed by nurse managers to make decisions and compare nursing practice across institutions and geographical areas1. The NMMDS is a profession-specific data set, developed through grounded theory, expert review panels, national Delphi surveys, focus groups, cross-sectional descriptive surveys, and a national consensus working conference2. It identifies common elements to represent nursing care delivery or the context of nursing care at the unit level or service line in any setting. The NMMDS provides managers and administrators
standardized data that be compared within and across settings to understand how the context of care can influence patient and staff outcomes. These common elements can be measured to demonstrate the nursing component alone or as a part of broader care outcomes. Data elements reflect nursing practice and were selected to represent the essence of nursing. The context of care describes the overall setting or experience in which care takes place, such as home, acute care, long term care, and ambulatory or alternative care sites.
The NMMDS Implementation Guide (IG) is a technical specification intended to guide the collection of data related to the context and support of direct health care delivery. NMMDS IG provides specifications regarding the precision in capturing, storing, and subsequently describing, analyzing, and comparing effects of patient care management and administrative interventions on complex health care outcomes.
The NMMDS IG is based upon the NMMDS survey 2007-2015 updates. It is a research-based data set originally developed in 1989 to identify, define, and test the core variables needed to quantify at the unit or service line level within which health care is delivered2. Initially, a focus group composed by nursing management and administration experts developed a list of management variables. After a pilot survey, a national Delphi survey was completed to
determine necessity, clarity, and collectability of these variables within the acute care delivery system at the University of Iowa2. The NMMDS research was extended, subsequently, to long term care, ambulatory care, home health care, and occupational health settings. The research included a partnership between The University of Iowa and the American Organization of Nurse Executives (AONE) in 1996 in order to disseminate and further refine those variables.
The NMMDS IG is expressed as a collection of data elements coded with the Logical Observation Identifiers Names and Codes (LOINC) standards. LOINC applies universal code names and identifiers to health terms related to laboratory and other clinical observations. Several standards organizations, such as Integrating the Healthcare Enterprise (IHE) or Health Level Seven (HL7), use LOINC to electronically transfer results from different reporting systems to the appropriate healthcare networks.
A variety of information systems are involved when mapping the NMMDS variables using the LOINC codes. These include human resource systems, scheduling, acuity, and electronic health records. For instance, human resource systems include many of the variables about staffing
Purpose
The purpose of this NMMDS IG is to serve as a measure to nurses and health information technology (HIT) staff in implementing the collection of the data elements of the Nursing
Management Minimum Data Set (NMMDS) in compliance with the LOINC terminology. The specification contains NMMDS elements with their specific LOINC mapping codes organized by sections according to the NMMDS hierarchy. Sections in the NMMDS IG contain NMMDS categories, data elements within the categories, conceptual and operational definition of each data element, recommendations for use where appropriate, and instructions about integration into information systems. These information systems may include electronic health records (EHRs), scheduling and / or human resource systems. Although the NMMDS has its own coding system, to support interoperability, the LOINC coding system should be integrated into electronic information systems. LOINC coding is provided in this document.
Audience
The primary audiences for this specification are nurse leaders, nurse informaticists, and HIT staff involved in implementing information systems and creating discrete measurement and analyses of the nursing component of health care. This audience will want to ensure that this specification adequately addresses the implementation of the NMMDS and their specific LOINC codes to support the national standards for interoperability.
Secondary users of this specification include nurses working in any context of clinical practice, researchers and educators. This audience is responsible for adopting this guide into clinical practice, incorporating the data elements into research designs, and disseminating the
NMMDS IG to students and novice nurses for advanced learning and expertise. Researchers and educators are key experts in advancing and adopting this specification, to ensure that NMMDS information is consistent with the best nursing practices and nursing data exchange across settings.
Contributors
This specification was developed under the sponsorship of the Center for Nursing Informatics, School of Nursing, University of Minnesota under the leadership of Connie W. Delaney, PhD, RN, FAAN, FACMI who is one of the two original developers of the NMMDS (along with Diane Huber, PhD, RN, FAAN) and Co-director for the Center. Content expertise, project management, technical insights, and workflow knowledge was provided by Bonnie L. Westra, PhD, RN, FAAN, FACMI, Director for the Center for Nursing Informatics. Additional guidance was provided by Susan A. Matney, PhD, RN, FAAN, chair of the LOINC nursing subcommittee nursing special interest group.
Description of the other contributors:
Role Name Contact
Author Connie Delaney [email protected]
Co-Author/Editor Bonnie L. Westra Lisiane Pruinelli
[email protected] [email protected] Initial Developers Diane Huber
Connie Delaney
[email protected] [email protected] Project Manager Lisiane Pruinelli [email protected] Project team members Jung In Park
Colleen Hart Lynn Choromanski Mary Jo Swanson Tylor Wagner Amar Subramanian Dorcas Kunkel Mary Jo Swanson [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]
Vocabulary Facilitator Susan Matney [email protected]
Project Sponsor Connie Delaney [email protected]
Subject Matter Expert Amy Garcia [email protected] Subject Matter Expert Barbara Caspers [email protected]
Scope
The scope of this specification is limited to implementing LOINC encoded NMMDS data. The specification is intended for use in the United States, but may be useful internationally. The NMMDS elements were mapped to LOINC database and encoded with LOINC identifiers. The associated answers are also mapped in the LOINC database and are encoded with LOINC Answer (LA) identifiers.
The in-scope data elements are specified in the NMMDS 2007 - 2015 update. The
resultant March 2015 version of the NMMDS data elements, served as the foundation for the IG. Details for guiding the implementation and use of the NMMDS data includes environment and nurse resource categories. Financial elements, listed in Appendix A, are part of the NMMDS 2007 version, but to date have not been updated. Thus, the 2007 Financial category and data elements are out of the scope of this specification.
The scope of this specification covers requirements that support standardized workforce nursing data. The specification complies with the National Database for Nursing Quality Indicators (NDNQI). This specification facilitates operation analysis, research and education. Use Case Scenario
The Use Case covered by this specification is the integration of the NMMDS data elements into information systems and the extraction and use of the data for quality improvement, clinical operations improvement, NDNQI benchmarking or to meet Magnet Status recognition, and for research. Informaticians/ HIT staff use the NMMDS definitions and LOINC codes for coding data in information systems, extraction, and aggregation of the NMMDS data elements (see Fig. 1).
Informaticians code NMMDS data elements using the NMMDS definitions and LOINC codes. They also create data extracts or reports from the data.
Nursing Managers and Administrators use aggregate data represented by NMMDS to:
o Make decisions for nursing and the health system that improve the health of populations and clinical processes
o Meet some NDNQI data reporting o Support data needed for Magnet Status
Researchers use NMMDS data (alone or in combination with other data) to address research questions such as the influence of nursing models or staff variables on patient outcomes i.e. prevention of falls.
SPECIFICATION OVERVIEW Organization of this Specification
The data elements in this specification are grouped according to two high level
categories: Environment and Nurse Resources. Each high level category contains NMMDS data elements with their associated number, name, definition, and specific LOINC mapping codes. Instructions about integration into information systems are included. The overall hierarchy of these data elements covered by this specification is illustrated in the flowchart below (Fig. 2).
Convention used in this Implementation Guide
This implementation guide follows formatting conventional.
1. The document is divided in Environment and Nurse Resources high level categories. 2. Each category has its own heading with its components. The original NMMDS code
number is presented after each subheading in parenthesis. Heading and subheadings are in Bold.
3. Each component has one or more data elements.
4. Each data element has a code number expressing the original coding present in the data set and as the hierarchy inside the terminology. When the NMMDS was updated, some data elements were discontinued, others added. Therefore, numbers may not be sequential.
5. Each data element code is followed by its name. Some of these data elements have definitions, others not. When data elements have definitions, they are present after the name.
6. Each data element code and associated name is presented in Italics.
7. Each data element definition is in regular font formatting.
8. When there is a need to emphasize some context, the word or sentence is in Underlined.
9. Some data elements may use external resources, such as websites. When these resources are present, the hyperlink is present.
10.A data element may have specific types of coding that can be combined with other data elements coding. These specific types of coding are under a title with bottom and top borders, and in Bold.
11.Data elements may be require (R), optional (O) or conditional (C)
12.The LOINC code for each data element is listed after each data element description. 13.The LOINC concept codes and LOINC answers are listed in tables with the
associated NMMDS specific code.
14.The type of answer for LOINC is listed in the last column for LOINC and labeled Ex. UCUM Units (Example Unified Code for Units of Measurement).
15.References for each element follow American Medical Association (AMA) guideline and are presented in the end of this implementation guide.
Use of Vocabulary Standards
LOINC is a laboratory and clinical terminology system focused on observation
information. LOINC was developed by Regenstrief Institute and the LOINC committee in 1994 and has historically focused on facilitating the exchange of laboratory information (chemistry, hematology, serology, microbiology, toxicology, cell counts, antibiotic susceptibilities, etc.). Subsequently, it was expanded to other clinical information class domains - vital signs, hemodynamics, intake/output, EKG, procedures, survey instruments, and other clinical observations and other assessments (Omaha System survey instruments, Patient Health Questionnaire set, HHS survey, MFS survey, etc.), management data (Nursing Management Minimum Data Set), and document types/attachments (ambulance reports, clinical reports, medication reports, laboratory reports, occupational therapy attachments, medical social work attachment, etc.).
The LOINC standardized coding system was chosen to map and distribute the NMMDS because the question-answer format of LOINC matched the format for the NMMDS. That is, each NMMDS data element and sub-element is a question with different types of answers. For instance, one NMMDS data element (19.02) asks for the percent of nurses on a unit or for a service line by gender. The answers are the percent for females, males, or unknown.
LOINC also provides an open source distribution of the LOINC coded NMMDS
(http:/loinc.org). The LOINC coding for the NMMDS is available in this implementation guide, as well as on the LOINC website and through LOINC’s downloadable software program called RELMA (Regenstrief LOINC Mapping Assistant).
NURSING MANAGEMENT MINIMUM DATA SET – NMMDS
The NMMDS document is a collection of data elements divided into two categories: Environment and Nurse Resources. Each of this category includes six unique data elements. Environment
The environment is the community and life-style aspects of health that influence client and family need and resources, and their relationship to health care3. The Environment category is composed of six data elements: Unit/Service Unique Identifier, Type of Nursing Delivery Unit/Service, Patient/Client Population, Volume of Nursing Structure and Outcomes,
Patient/Client Accessibility, and Accreditation/Certification/Licensure. Nurse Resources
The Nurse Resources category is at the leadership level (management/administration), where nurses in executive nursing practice identify commonalities, as well as differences, of personnel and conditions that are associated with care and care delivery. This category provides elements to measure the care and resource inputs within each setting and across two or more settings3. Nurse Resources component has six data elements: Staffing, Satisfaction, Nurse Demographics per Unit or Service, Clinical Mental Work, Environmental Conditions, and Electronic Health Records (EHR) Implementation Stages.
COMPONENT - ENVIRONMENT 01 Facility Unique Identifiers
A facility is the highest level of an organization for data aggregation for which unit level data are reported. In some cases, a facility is the same as a unit if there is only one unit.
01.01 Federal Provider Number Facility – The National Provide Identifier (NPI) is a
unique identification number for health care providers specified by HIPAA. For the NMMDS, the NPI for organizations will be used to indicate the place that sends the bill. https://nppes.cms.hhs.gov/NPPES/Welcome.do (Heart association, Catholic Charities)
01.12 Facility Name – Legal name of the facility
01.07 Geographic location – State or Territory of the facility where the service was provided or originated as defined by the United States Postal Service
(http://www.itl.nist.gov/fipspubs/)
01.08 Postal Location (zip code) – zip code of the facility where service was provided or originated as defined by the United States Postal Service –use a nine digit if possible (http://zip4.usps.com/zip4/citytown_zip.jsp).
01.10 Place of Service – Place of service is the location, as indicated on health care professional claims forms, where the service was provided or originated. It is represented by two-digit codes as defined by Centers for Medicare & Medicaid Services (CMS).
(http://www.cms.hhs.gov/PlaceofServiceCodes/Downloads/placeofservice.pdf) The NMMDS uses the CMS list plus additional codes that end with an “x”.
1X Stores – these may include grocery, pharmacy, department or other stores where retail goods and merchandise are sold
2X Voluntary Health or Charitable Agencies - (e.g., National Cancer Society)
01.11 Reporting period – Starting through end date for the period of time in which events occurred – not when the data are collected or reported
01.11.01 Start Date/Time 01.11.02 End Date/Time LOINC Coding
LOINC Code NMMDS Component Data Type NMMDS Code
52826-5 NMMDS panel Facility Answer List
52827-3 Facility unique identifier panel Panel 01 45399-3 Federal provider number Facility Enumerated (See
Link)
01.01 52828-1 Federal provider name Facility Text 01.12 52830-7 State, district or territory federal
abbreviation Facility
Enumerated (See Link)
01.07
52831-5 ZIP code Facility Enumerated (See
Link)
01.08
52829-9 Place of service Enumerated (See
Link)
01.10 52832-3 Survey reporting period start date
Facility
Date 01.11.01
52833-1 Survey reporting period end date Facility
Date 01.11.02
02 Type of Nursing Delivery Unit/Service
The unique name, identifier, and type of nursing unit or service for each component of the facility.
02.01 Unique Unit Cost Center – An identifier given to a cost center by the facility for a unit which only has meaning within the facility; this is the first level of data aggregation beyond the individual patient or care provider.
02.02 Unique Unit Name – The name assigned to a unit by the facility, which only has meaning within the facility.
02.04 Type of Nursing Delivery Unit or Service – Select all categories that most accurately describe the unit type or specialty (This is the NDNQI List In Appendix D
http://www.nursingquality.org/Documents/Public/APPENDIX%20D.pdf).
02.04.01 Adult Critical Care Unit
02.04.01.01 Adult Burn Critical Care Unit
02.04.01.02 Adult Cardiothoracic Critical Care Unit 02.04.01.03 Adult Coronary Critical Care Unit 02.04.01.04 Adult Medical Critical Care Unit 02.04.01.05 Adult Neurology Critical Care Unit
02.04.01.06 Adult Pulmonary Critical Care Unit 02.04.01.07 Adult Surgical Critical Care Unit 02.04.01.08 Adult Trauma Critical Care Unit 02.04.02 Adult Step-down Unit
02.04.02.01 Adult Med-Surg Step-down Unit 02.04.02.02 Adult Medical Step-down Unit 02.04.02.03 Adult Surgical Step-down Unit 02.04.03 Adult Medical Unit
02.04.03.01 Adult Bone Marrow Transplant Medical Unit 02.04.03.02 Adult Cardiac Medical Unit
02.04.03.03 Adult Gastrointestinal Medical Unit 02.04.03.04 Adult Infectious Disease Medical Unit 02.04.03.05 Adult Neurology Medical Unit
02.04.03.06 Adult Oncology Medical Unit 02.04.03.07 Adult Renal Medical Unit 02.04.03.08 Adult Respiratory Medical Unit 02.04.04 Adult Surgical Unit
02.04.04.01 Adult Bariatric Surgical Unit 02.04.04.02 Adult Cardiothoracic Surgical Unit 02.04.04.03 Adult Gynecology Surgical Unit 02.04.04.04 Adult Neurosurgery Surgical Unit 02.04.04.05 Adult Orthopedic Surgical Unit 02.04.04.06 Adult Plastics Surgical Unit 02.04.04.07 Adult Transplant Surgical Unit 02.04.04.08 Adult Trauma Surgical Unit 02.04.05 Adult Med-Surg Combination Unit
02.04.05.01 Adult Cardiac Med-Surg Combination Unit
02.04.05.03 Adult Oncology Med-Surg Combination Unit 02.04.06 Adult Obstetrics Unit
02.04.06.01 Adult Obstetrics Ante-Partum Unit 02.04.06.02 Adult Obstetrics Labor & Delivery Unit 02.04.06.03 Adult Obstetrics Mother/Baby Combined Unit 02.04.06.04 Adult Obstetrics Post-Partum Unit
02.04.07 Other Adult Skilled Nursing Unit 02.04.08 Other Adult Mixed Acuity Unit
02.04.09 Neonatal Level I Neonate-Continuing Care Unit 02.04.10 Neonatal Level II Neonate-Intermediate Care Unit 02.04.11 Neonatal Level III/IV Neonatal Critical Care Unit 02.04.12 Neonatal Well Baby Nursery Unit
02.04.13 Neonatal Mixed Acuity Unit 02.04.14 Adult Rehabilitation Unit
02.04.14.01 Adult Brain Injury/Spinal Cord Injury Rehabilitation Unit 02.04.14.02 Adult Cardiopulmonary Rehabilitation Unit
02.04.14.03 Adult Neurology/Stroke Rehabilitation Unit 02.04.14.04 Adult Orthopedic/Amputee Rehabilitation Unit 02.04.15 Pediatric Rehabilitation Unit
02.04.16 Mixed Acuity Rehabilitation Unit 02.04.17 Pediatric Critical Care Unit
02.04.17.01 Pediatric Burn Critical Care Unit
02.04.17.02 Pediatric Cardiothoracic Critical Care Unit 02.04.17.03 Pediatric Coronary Critical Care Unit 02.04.17.04 Pediatric Medical Critical Care Unit 02.04.17.05 Pediatric Neurology Critical Care Unit 02.04.17.06 Pediatric Pulmonary Critical Care Unit 02.04.17.07 Pediatric Surgical Critical Care Unit
02.04.17.08 Pediatric Trauma Critical Care Unit 02.04.18 Pediatric Step Down Unit
02.04.18.01 Pediatric Med-Surg Step-down Unit 02.04.18.02 Pediatric Medical Step-down Unit 02.04.18.03 Pediatric Surgical Step-down Unit 02.04.19 Pediatric Medical Unit
02.04.19.01 Pediatric Bone Marrow Transplant Medical Unit 02.04.19.02 Pediatric Cardiac Medical Unit
02.04.19.03 Pediatric Gastrointestinal Medical Unit 02.04.19.04 Pediatric Infectious Disease Medical Unit 02.04.19.05 Pediatric Neurology Medical Unit
02.04.19.06 Pediatric Oncology Medical Unit 02.04.19.07 Pediatric Renal Medical Unit 02.04.19.08 Pediatric Respiratory Medical Unit 02.04.20 Pediatric Surgical Unit
02.04.20.01 Pediatric Bariatric Surgical Unit 02.04.20.02 Pediatric Cardiothoracic Surgical Unit 02.04.20.03 Pediatric Gynecology Surgical Unit 02.04.20.04 Pediatric Neurosurgery Surgical Unit 02.04.20.05 Pediatric Orthopedic Surgical Unit 02.04.20.06 Pediatric Plastics Surgical Unit 02.04.20.07 Pediatric Transplant Surgical Unit 02.04.20.08 Pediatric Trauma Surgical Unit 02.04.21 Pediatric Med-Surg Combination Unit
02.04.21.01 Pediatric Cardiac Med-Surg Combination Unit 02.04.21.02 Pediatric Neurology/Neurosurgery Combination Unit 02.04.21.03 Pediatric Oncology Med-Surg Combination Unit 02.04.22 Pediatric Mixed Acuity Unit
02.04.23 Adult Psychiatric Inpatient Unit
02.04.23.01 Adult General Psychiatric Inpatient Unit 02.04.23.02 Adult Intensive Psychiatric Inpatient Unit 02.04.23.03 Adult Mixed Acuity Psychiatric Inpatient Unit 02.04.24 Adolescent Psychiatric Inpatient Unit
02.04.24.01 Adolescent General Psychiatric Inpatient Unit 02.04.24.02 Adolescent Intensive Psychiatric Inpatient Unit 02.04.24.03 Adolescent Mixed Acuity Psychiatric Inpatient Unit 02.04.25 Child Psychiatric Inpatient Unit
02.04.25.01 Child General Psychiatric Inpatient Unit 02.04.25.02 Child Intensive Psychiatric Inpatient Unit 02.04.25.03 Child Mixed Acuity Psychiatric Inpatient Unit 02.04.26 Child-Adolescent Psychiatric Inpatient Unit
02.04.26.01 Child-Adolescent General Psychiatric Inpatient Unit 02.04.26.02 Child-Adolescent Intensive Psychiatric Inpatient Unit 02.04.26.03 Child-Adolescent Mixed Acuity Psychiatric Inpatient Unit 02.04.27 Geripsych Inpatient Unit
02.04.27.01 Geripsych General Psychiatric Inpatient Unit 02.04.27.02 Geripsych Intensive Psychiatric Inpatient Unit 02.04.27.03 Geripsych Mixed Acuity Psychiatric Inpatient Unit 02.04.28 Behavioral Health Inpatient Unit
02.04.28.01 Behavioral Health General Psychiatric Inpatient Unit 02.04.28.02 Behavioral Health Intensive Psychiatric Inpatient Unit 02.04.28.03 Behavioral Health Mixed Acuity Psychiatric Inpatient Unit 02.04.29 Specialty Psychiatric Inpatient Unit
02.04.29.01 Specialty Psychiatric General Inpatient Unit 02.04.29.02 Specialty Psychiatric Intensive Inpatient Unit 02.04.29.03 Specialty Psychiatric Mixed Acuity Inpatient Unit
02.04.30 Multiple Psychiatric Unit Types Inpatient Unit
02.04.30.01 Multiple Psychiatric Unit Types General Inpatient Unit 02.04.30.02 Multiple Psychiatric Unit Types Intensive Inpatient Unit 02.04.30.03 Multiple Psychiatric Unit Types Mixed Acuity Inpatient Unit 02.04.31 Other Psychiatric Inpatient or Outpatient Units
02.04.31.01 Psychiatric Day Hospital 02.04.31.02 Outpatient Psychiatric Clinics
02.04.31.03 Psychiatric Residential Unit (no 24/7 nurse) 02.04.32 Emergency Department
02.04.32.01 General Emergency Department 02.04.32.02 Obstetrics Emergency Department 02.04.32.03 Pediatric Emergency Department 02.04.32.04 Urgent Care Emergency Department 02.04.33 Peri-operative Unit
02.04.33.01 Post Anesthesia Care Unit 02.04.33.02 Pre-Op Holding
02.04.33.03 Operating Room
02.04.33.04 Same Day/Ambulatory Surgery 02.04.34 General Ambulatory Care
02.04.34.01 Cardiac Rehabilitation Clinic 02.04.34.02 Outpatient Clinics
02.04.34.03 Outpatient Rehabilitation Clinic 02.04.34.04 Radiation Therapy Clinic 02.04.34.05 Wound Care Clinic 02.04.35 Interventional Unit
02.04.35.01 Bronchoscopy Unit 02.04.35.02 Catheterization Lab Unit 02.04.35.03 Dialysis Unit
02.04.35.04 Gastrointestinal Clinic 02.04.35.05 Infusion Unit
02.04.35.06 Pain Management Unit 02.04.35.07 Radiology Unit
02.04.35.08 Short Stay Unit 02.04.36 Other Clinic ou Unit
02.04.36.01 Home Health Clinic
02.04.36.02 Hospice/Palliative Care Clinic 02.04.36.03 Long Term Care Unit
02.04.36.04 Patient Preparation/Education Clinic 02.04.36.05 Work Group Clinic
02.04.36.06 Public Health Clinic 02.04.36.07 School Health Clinic 02.04.36.08 Aerospace Clinic 02.04.36.09 Continence Care Clinic 02.04.36.10 Flight Clinic
02.04.36.11 Genetics/Genetics Counseling Clinic 02.04.36.12 Health Promotion Clinic
02.04.36.13 Infection Control Clinic 02.04.36.14 Nutrition Support Clinic 02.04.36.15 Occupational Health Clinic 02.04.36.16 Ophthalmic Clinic
02.04.36.17 Ostomy Care Clinic
02.04.36.18 Reproductive Endocrinology/Infertility Clinic 02.04.36.19 Women's Health Care, Ambulatory Clinic
LOINC Coding
LOINC Code NMMDS Component Data Type NMMDS Code
52826-5 NMMDS panel Facility Answer ID NMMDS Code
52834-9 NMMDS nursing delivery unit or service panel Facility
02
52836-4 Nursing unit cost center Text 02.01
52835-6 Nursing unit name Text 02.02
52837-2 Type of nursing unit or service [NDNQI] LL599-2 02.04
LOINC Answer List
52837-2 - Type of nursing unit or service [NDNQI] – Answer Set – these are the potential values for Type of nursing unit or service from NORMATIVE ANSWER LIST LL599-2. Data can be captured at the higher level which are NMMDS codes that are 02.04.xx or at more granular level, which are codes that are 02.04.xx.xx.
Sequence # NMMDS Component Answer ID NMMDS Code 1 Adult Critical Care Unit LA10142-0 02.04.01
2 Adult Burn Critical Care Unit LA10143-8 02.04.01.01 3 Adult Cardiothoracic Critical Care Unit LA10144-6 02.04.01.02 4 Adult Coronary Critical Care Unit LA10145-3 02.04.01.03 5 Adult Medical Critical Care Unit LA10146-1 02.04.01.04 6 Adult Neurology Critical Care Unit LA10147-9 02.04.01.05 7 Adult Pulmonary Critical Care Unit LA10148-7 02.04.01.06 8 Adult Surgical Critical Care Unit LA10149-5 02.04.01.07 9 Adult Trauma Critical Care Unit LA10150-3 02.04.01.08 10 Adult Step-down Unit LA10151-1 02.04.02 11 Adult Med-Surg Step-down Unit LA10152-9 02.04.02.01 12 Adult Medical Step-down Unit LA10153-7 02.04.02.02 13 Adult Surgical Step-down Unit LA10154-5 02.04.02.03 14 Adult Medical Unit LA10155-2 02.04.03 15 Adult Bone Marrow Transplant Medical
Unit
LA10156-0 02.04.03.01 16 Adult Cardiac Medical Unit LA10157-8 02.04.03.02 17 Adult Gastrointestinal Medical Unit LA10158-6 02.04.03.03 18 Adult Infectious Disease Medical Unit LA10159-4 02.04.03.04 19 Adult Neurology Medical Unit LA10160-2 02.04.03.05 20 Adult Oncology Medical Unit LA10161-0 02.04.03.06 21 Adult Renal Medical Unit LA10162-8 02.04.03.07 22 Adult Respiratory Medical Unit LA10163-6 02.04.03.08 23 Adult Surgical Unit LA10164-4 02.04.04 24 Adult Bariatric Surgical Unit LA10165-1 02.04.04.01 25 Adult Cardiothoracic Surgical Unit LA10166-9 02.04.04.02
26 Adult Gynecology Surgical Unit LA10167-7 02.04.04.03 27 Adult Neurosurgery Surgical Unit LA10168-5 02.04.04.04 28 Adult Orthopedic Surgical Unit LA10169-3 02.04.04.05 29 Adult Plastics Surgical Unit LA10170-1 02.04.04.06 30 Adult Transplant Surgical Unit LA10171-9 02.04.04.07 31 Adult Trauma Surgical Unit LA10172-7 02.04.04.08 32 Adult Med-Surg Combination Unit LA10173-5 02.04.05 33 Adult Cardiac Med-Surg Combination
Unit
LA10174-3 02.04.05.01 34 Adult Neuro/Neurosurgery Med-Surg
Combination Unit
LA10175-0 02.04.05.02 35 Adult Oncology Med-Surg Combination
Unit
LA10176-8 02.04.05.03 36 Adult Obstetrics Unit LA10177-6 02.04.06 37 Adult Obstetrics Ante-Partum Unit LA10178-4 02.04.06.01 38 Adult Obstetrics Labor & Delivery Unit LA10179-2 02.04.06.02 39 Adult Obstetrics Mother/Baby Combined
Unit
LA10180-0 02.04.06.03 40 Adult Obstetrics Post-Partum Unit LA10181-8 02.04.06.04 41 Other Adult Skilled Nursing Unit LA10182-6 02.04.07 42 Other Adult Mixed Acuity Unit LA10183-4 02.04.08 43 Neonatal Level I Neonate-Continuing Care
Unit
LA10184-2 02.04.09 44 Neonatal Level II Neonate-Intermediate
Care Unit
LA10185-9 02.04.10 45 Neonatal Level III/IV Neonatal Critical
Care Unit
LA10186-7 02.04.11 46 Neonatal Well Baby Nursery Unit LA10187-5 02.04.12 47 Neonatal Mixed Acuity Unit LA10188-3 02.04.13 48 Adult Rehabilitation Unit LA10189-1 02.04.14 49 Adult Brain Injury/Spinal Cord Injury
Rehabilitation Unit
LA10190-9 02.04.14.01 50 Adult Cardiopulmonary Rehabilitation
Unit
LA10191-7 02.04.14.02 51 Adult Neurology/Stroke Rehabilitation
Unit
LA10192-5 02.04.14.03 52 Adult Orthopedic/Amputee Rehabilitation
Unit
LA10193-3 02.04.14.04 53 Pediatric Rehabilitation Unit LA10194-1 02.04.15 54 Mixed Acuity Rehabilitation Unit LA10195-8 02.04.16 55 Pediatric Critical Care Unit LA10196-6 02.04.17 56 Pediatric Burn Critical Care Unit LA10197-4 02.04.17.01 57 Pediatric Cardiothoracic Critical Care
Unit
LA10198-2 02.04.17.02 58 Pediatric Coronary Critical Care Unit LA10199-0 02.04.17.03 59 Pediatric Medical Critical Care Unit LA10200-6 02.04.17.04
60 Pediatric Neurology Critical Care Unit LA10201-4 02.04.17.05 61 Pediatric Pulmonary Critical Care Unit LA10202-2 02.04.17.06 62 Pediatric Surgical Critical Care Unit LA10203-0 02.04.17.07 63 Pediatric Trauma Critical Care Unit LA10204-8 02.04.17.08 64 Pediatric Step Down Unit LA10205-5 02.04.18 65 Pediatric Med-Surg Step-down Unit LA10206-3 02.04.18.01 66 Pediatric Medical Step-down Unit LA10207-1 02.04.18.02 67 Pediatric Surgical Step-down Unit LA10208-9 02.04.18.03 68 Pediatric Medical Unit LA10209-7 02.04.19 69 Pediatric Bone Marrow Transplant
Medical Unit
LA10210-5 02.04.19.01 70 Pediatric Cardiac Medical Unit LA10211-3 02.04.19.02 71 Pediatric Gastrointestinal Medical Unit LA10212-1 02.04.19.03 72 Pediatric Infectious Disease Medical
Unit
LA10213-9 02.04.19.04 73 Pediatric Neurology Medical Unit LA10214-7 02.04.19.05 74 Pediatric Oncology Medical Unit LA10215-4 02.04.19.06 75 Pediatric Renal Medical Unit LA10216-2 02.04.19.07 76 Pediatric Respiratory Medical Unit LA10217-0 02.04.19.08 77 Pediatric Surgical Unit LA10218-8 02.04.20 78 Pediatric Bariatric Surgical Unit LA10219-6 02.04.20.01 79 Pediatric Cardiothoracic Surgical Unit LA10220-4 02.04.20.02 80 Pediatric Gynecology Surgical Unit LA10221-2 02.04.20.03 81 Pediatric Neurosurgery Surgical Unit LA10222-0 02.04.20.04 82 Pediatric Orthopedic Surgical Unit LA10223-8 02.04.20.05 83 Pediatric Plastics Surgical Unit LA10224-6 02.04.20.06 84 Pediatric Transplant Surgical Unit LA10225-3 02.04.20.07 85 Pediatric Trauma Surgical Unit LA10226-1 02.04.20.08 86 Pediatric Med-Surg Combination Unit LA10227-9 02.04.21 87 Pediatric Cardiac Med-Surg Combination
Unit
LA10228-7 02.04.21.01 88 Pediatric Neurology/Neurosurgery
Combination Unit
LA10229-5 02.04.21.02 89 Pediatric Oncology Med-Surg
Combination Unit
LA10230-3 02.04.21.03 90 Pediatric Mixed Acuity Unit LA10231-1 02.04.22 91 Adult Psychiatric Inpatient Unit LA10232-9 02.04.23 92 Adult General Psychiatric Inpatient Unit LA10233-7 02.04.23.01 93 Adult Intensive Psychiatric Inpatient
Unit
LA10234-5 02.04.23.02 94 Adult Mixed Acuity Psychiatric Inpatient
Unit
LA10235-2 02.04.23.03 95 Adolescent Psychiatric Inpatient Unit LA10236-0 02.04.24 96 Adolescent General Psychiatric Inpatient
Unit
97 Adolescent Intensive Psychiatric Inpatient Unit
LA10238-6 02.04.24.02 98 Adolescent Mixed Acuity Psychiatric
Inpatient Unit
LA10239-4 02.04.24.03 99 Child Psychiatric Inpatient Unit LA10240-2 02.04.25 100 Child General Psychiatric Inpatient Unit LA10241-0 02.04.25.01 101 Child Intensive Psychiatric Inpatient
Unit
LA10242-8 02.04.25.02 102 Child Mixed Acuity Psychiatric Inpatient
Unit
LA10243-6 02.04.25.03 103 Child-Adolescent Psychiatric Inpatient
Unit
LA10244-4 02.04.26 104 Child-Adolescent General Psychiatric
Inpatient Unit
LA10245-1 02.04.26.01 105 Child-Adolescent Intensive Psychiatric
Inpatient Unit
LA10246-9 02.04.26.02 106 Child-Adolescent Mixed Acuity
Psychiatric Inpatient Unit
LA10247-7 02.04.26.03 107 Geripsych Inpatient Unit LA10248-5 02.04.27 108 Geripsych General Psychiatric Inpatient
Unit
LA10249-3 02.04.27.01 109 Geripsych Intensive Psychiatric Inpatient
Unit
LA10250-1 02.04.27.02 110 Geripsych Mixed Acuity Psychiatric
Inpatient Unit
LA10251-9 02.04.27.03 111 Behavioral Health Inpatient Unit LA10252-7 02.04.28 112 Behavioral Health General Psychiatric
Inpatient Unit
LA10253-5 02.04.28.01 113 Behavioral Health Intensive Psychiatric
Inpatient Unit
LA10254-3 02.04.28.02 114 Behavioral Health Mixed Acuity
Psychiatric Inpatient Unit
LA10255-0 02.04.28.03 115 Specialty Psychiatric Inpatient Unit LA10256-8 02.04.29 116 Specialty Psychiatric General Inpatient
Unit
LA10257-6 02.04.29.01 117 Specialty Psychiatric Intensive Inpatient
Unit
LA10258-4 02.04.29.02 118 Specialty Psychiatric Mixed Acuity
Inpatient Unit
LA10259-2 02.04.29.03 119 Multiple Psychiatric Unit Types Inpatient
Unit
LA10260-0 02.04.30 120 Multiple Psychiatric Unit Types General
Inpatient Unit
LA10261-8 02.04.30.01 121 Multiple Psychiatric Unit Types Intensive
Inpatient Unit
122 Multiple Psychiatric Unit Types Mixed Acuity Inpatient Unit
LA10263-4 02.04.30.03 123 Other Psychiatric Inpatient or Outpatient
Units
LA10264-2 02.04.31 124 Psychiatric Day Hospital LA10265-9 02.04.31.01 125 Outpatient Psychiatric Clinics LA10266-7 02.04.31.02 126 Psychiatric Residential Unit (no 24/7
nurse)
LA10267-5 02.04.31.03 127 Emergency Department LA10268-3 02.04.32 128 General Emergency Department LA10269-1 02.04.32.01 129 Obstetrics Emergency Department LA10270-9 02.04.32.02 130 Pediatric Emergency Department LA10271-7 02.04.32.03 131 Urgent Care Emergency Department LA10272-5 02.04.32.04 132 Peri-operative Unit LA10273-3 02.04.33 133 Post Anesthesia Care Unit LA10274-1 02.04.33.01
134 Pre-Op Holding LA10275-8 02.04.33.02
135 Operating room LA7222-8 02.04.33.03
136 Same Day/Ambulatory Surgery LA10277-4 02.04.33.04 137 General Ambulatory Care LA10278-2 02.04.34 138 Cardiac Rehabilitation Clinic LA10279-0 02.04.34.01 139 Outpatient Clinics LA10280-8 02.04.34.02 140 Outpatient Rehabilitation Clinic LA10281-6 02.04.34.03 141 Radiation Therapy Clinic LA10282-4 02.04.34.04
142 Wound Care Clinic LA10283-2 02.04.34.05
143 Interventional Unit LA10284-0 02.04.35
144 Bronchoscopy Unit LA10285-7 02.04.35.01
145 Catheterization Lab Unit LA10286-5 02.04.35.02
146 Dialysis unit LA10287-3 02.04.35.03
147 Gastrointestinal Clinic LA10288-1 02.04.35.04
148 Infusion Unit LA10289-9 02.04.35.05
149 Pain Management Unit LA10290-7 02.04.35.06
150 Radiology Unit LA10291-5 02.04.35.07
151 Short Stay Unit LA10292-3 02.04.35.08
152 Other Unit or Clinic LA10293-1 02.04.36 153 Home Health Clinic LA10294-9 02.04.36.01 154 Hospice/Palliative Care Unit LA10295-6 02.04.36.02 155 Long Term Care Unit LA10296-4 02.04.36.03 156 Patient Preparation/Education Clinic LA10297-2 02.04.36.04
157 Work Group Clinic LA10298-0 02.04.36.05
158 Public Health Clinic LA10299-8 02.04.36.06 159 School Health Clinic LA10300-4 02.04.36.07
160 Aerospace Clinic LA10301-2 02.04.36.08
161 Continence Care Clinic LA10302-0 02.04.36.09
162 Flight Clinic LA10303-8 02.04.36.10
164 Health Promotion Clinic LA10305-3 02.04.36.12 165 Infection Control Clinic LA10306-1 02.04.36.13 166 Nutrition Support Clinic LA10307-9 02.04.36.14 167 Occupational Health Clinic LA10308-7 02.04.36.15
168 Ophthalmic Clinic LA10309-5 02.04.36.16
169 Ostomy Care Clinic LA10310-3 02.04.36.17 170 Reproductive Endocrinology/Infertility
Clinic
LA10311-1 02.04.36.18 171 Women's Health Care, Ambulatory
Clinic
LA10312-9 02.04.36.19
03 Patient/Client Population
Characteristics of the population served by nursing delivery unit or service. Identify all
categories that best describe the actual patient/client population served by the nursing delivery unit/service.
03.02 Chronological age – Percent of the population during the reporting period of the appropriate age served on the nursing delivery unit or service (this is a
modification of age categories listed at
http://www.seer.cancer.gov/stdpopulations/stdpop.19ages.html) 03.02.01 Fetal 03.02.02 0 – 28 days (neonatal) 03.02.03 29 days - 1 year 03.02.04 01-04 years 03.02.05 05-09 years 03.02.06 10-14 years 03.02.07 15-19 years 03.02.08 20-24 years 03.02.09 25-29 years 03.02.10 30-34 years 03.02.11 35-39 years 03.02.12 40-44 years 03.02.13 45-49 years
03.02.14 50-54 years 03.02.15 55-59 years 03.02.16 60-64 years 03.02.17 65-69 years 03.02.18 70-74 years 03.02.19 75-79 years 03.02.20 80-84 years 03.02.21 85+ years
03.03 Catchment Area – This is an estimate of the percent of patients served by this nursing delivery unit or service by geographical area. Select the smallest geographical unit that best fits the population served.
03.03.01 Neighborhood 03.03.02 City or Town
03.03.03 District catchment area 03.03.04 County catchment area 03.03.05 Parish catchment area 03.03.06 State catchment area 03.03.07 Region catchment area 03.03.08 Nation catchment area 03.03.09 World catchment area 03.03.10 Aerospace catchment area 03.03.11 Nautical catchment area
03.04 Total Patient Population – a count of the patient population during the reporting period.
LOINC Coding
LOINC Code LOINC component Data Type NMMDS Code
Patient/Client Population 03
52839-0 Population distribution panel (chronological age)
% for each age group
52861-2 Catchment area panel population % for each catchment group
03.03
52839-8 Total patient population # # 03.04
LOINC Answer List
52839-0 Population distribution panel (chronological age) [NMMDS] – use answers below Sequence # NMMDS Component Answer Type NMMDS Code
52839-0 Population distribution panel (chronological age) 03.02 52840-6 Total population of fetal age population % 03.02.01 52841-4 Total population of age birth to 28 days
population
% 03.02.02
52842-2 Total population of age 29 days to 1 year population
% 03.02.03
52843-0 Total population of age 1-4 years population % 03.02.04 52844-8 Total population of age 5-9 years population % 03.02.05 52845-5 Total population of age 10-14 years population % 03.02.06 52846-3 Total population of age 15-19 years population % 03.02.07 52847-1 Total population of age 20-24 years population % 03.02.08 52848-9 Total population of age 25-29 years population % 03.02.09 52849-7 Total population of age 30-34 years population % 03.02.10 52850-5 Total population of age 35-39 years population % 03.02.12 52851-3 Total population of age 40-44 years population % 03.02.13 52852-1 Total population of age 45-49 years population % 03.02.14 52853-9 Total population of age 50-54 years population % 03.02.15 52854-7 Total population of age 55-59 years population % 03.02.16 52855-4 Total population of age 60-64 years population % 03.02.17 52856-2 Total population of age 65-69 years population % 03.02.18 52857-0 Total population of age 70-74 years population % 03.02.19 52859-6 Total population of age 80-84 years population % 03.02.20 52860-4 Total population of age GE 85 years population % 03.02.21
52861-2 Catchment area panel population [NMMDS] – use answers below
Sequence# NMMDS Component Answer Type NMMDS Code
52861-2 Catchment area panel population 03.03
52862-0 Neighborhood catchment area population [Estimated]
% 03.03.01
52863-8 City or town catchment area population [Estimated]
% 03.03.02
52864-6 District catchment area population [Estimated] % 03.03.03 52865-3 County catchment area population [Estimated] % 03.03.04 52866-1 Parish catchment area population [Estimated] % 03.03.05
52867-9 State catchment area population [Estimated] % 03.03.06 52868-7 Region catchment area population [Estimated] % 03.03.07 52869-5 Nation catchment area population [Estimated] % 03.03.08 52870-3 World catchment area population [Estimated] % 03.03.09 52871-1 Aerospace catchment area population
[Estimated]
% 03.03.10
52872-9 Nautical catchment area population [Estimated] % 03.03.11
04 Volume of Nursing Delivery Unit/Service
The number of nursing encounters with related hours for direct and indirect activities that can be associated with the provision of care to a client for a unit or service during a reporting
period. The volume of nursing care is determined by combining a type of encounter with a type of nursing provider with a type of client and then either the designated number of hours per encounter, maximum number of encounters possible or actual number of encounters on a unit for a reporting period. An encounteris an interaction between a provider and a client for the direct provision of health care service(s)4,5.
04.01 Type of Nursing Provider - A designation for nursing personnel based on educational preparation, licensure, or certification.
04.01.01 Certified Advanced Practice Nurse (APN) 04.01.02 Registered Nurse, not APN
04.01.03 Licensed Practical/ Vocational Nurse (LPN/ LVN)
04.01.04 Unlicensed Assistive Personnel (UAP) i.e. nursing assistant or home health aide
04.01.05 Total nursing personnel that includes APN, registered nurse, LPN/ LVN, and UAP
04.02 Type of Client
04.02.01 Individual Client- An individual who can be uniquely identified6,7 and is the recipient of health care or health related services5.
04.02.01 Family - Two or more individuals affiliated by marriage, birth,
adoption, biologic, legal ties, social relationships, significant or close other as identified by the patient or client as family7-10.
04.02.02 Population – A group of individuals living in a specific geographic area (e.g., a neighborhood, community, city, or county) or associated with a particular group (e.g. race, ethnicity, age) who experience or are at risk for common health related issues (e.g., exposures, health care resources, outcomes, etc.)11.
04.03 Type of Encounter
04.03.01 Patient Days- the patient census for a unit or service in a 24 hour period12.
04.03.02 Method 1: Patient Days: Midnight Census –“The daily number should be summed for every day in the month”12(p1).
04.03.03 Method 2: Patient Days: Midnight Census plus Actual Hours for Short Stay Patients - “The short stay “days” should be reported separately from midnight census and will be summed by NDNQI to obtain patient days. The total daily hours for short stay patients should be summed for the month and divided by 24”12(p1).
04.03.04 Method 3: Patient Days: Midnight Census plus Average Hours for Short Stay Patients - The short stay average is to be obtained from a special study documenting the time spent by short stay patients on specific unit types. Average short stay days should be reported separately and are added with midnight census to obtain patient days. The average daily hours should be multiplied by the number of days in the month and the product divided by 24 to produce average short stay days12(p2).
04.03.01 Method 4: Patient Days: Actual Hours - Sum actual hours for all patients, whether in-patient or short stay, and divide by 2412(p2).
04.03.01 Method 5: Patient Days from multiple Census Reports - A sum of the daily average censuses can be calculated to determine patient days for the month on the unit12(p2).
04.03.01 Visits - A provider-patient interaction either in person or via telehealth or other face-face technologies.
04.03.01 Consults – An interaction with a client for whom the nurse is not the primary care provider and was requested to see the client for advice, share information, or exchange views13.
04.03.01 Contacts -An interaction with a client that is not otherwise counted in other categories. Examples might be phone calls, mailing, emailing or other methods of connecting with a patient.
04.03.01 Programs -A focal area of health for groups, communities or
populations for which various activities can be associated. Typically this is used in public health such as for TB management and includes interventions such as program planning, management, and evaluation; case finding; education; advocacy; outreach; coalition building; etc. If an activity is included under program, do not include it under other categories such as classes.
04.03.01 Classes - Two or more patients with a common learning need for which knowledge, skills or attitudes are addressed.
04.04 Number of Hours Designated per Encounter - Estimate of direct and indirect hours of nursing care that are client related “…including nursing activities that occur away from the …[client] (e.g., care coordination, documentation time, travel time, treatment planning)”14. This category does not include all paid hours when activities cannot be directly attributable to the care of a specific client (e.g., sick time, vacation, education leave or orientation)14. Designated hours of nursing care include hours worked by employees or contract nursing staff, i.e., APN, RN, LPN/LVN, unlicensed assistive personnel (UAP)15.
04.05 Encounter Capacity –estimate of the number of encounters during a reporting period that could be provided for a unit or service. The estimate is derived from budgeted care on a unit or service for the reporting period.
04.06 Actual Encounters – the actual number of encounters during the reporting period
by type of encounter selected for a unit or service.
LOINC Coding
57126-5 Volume of nursing delivery unit or service panel
04
57120-8 Type of nursing provider [NMMDS] LL767-5 04.01
57121-6 Type of client [NMMDS] LL768-3 04.02
57122-4 Type of encounter [NMMDS] LL769-1 04.03
57123-2 Hours designated [Estimate] h 04.04
57124-0 Care capacity # [Estimate] {#} 04.05
57125-7 Care provided # {#} 04.06
LOINC Answer List
57120-8 Type of nursing provider [NMMDS] - Normative answer list (LL767-5)
Sequence # NMMDS Component Answer ID NMMDS Code
1 APN LA12063-6 04.01.01
2 RN LA6367-2 04.01.02
3 LPN/ LVN LA12071-9 04.01.03
4 UAP LA12085-9 04.01.04
5 Total nursing personnel LA12083-4 04.01.05
57121-6 Type of client [NMMDS] - Normative answer list (LL768-3)
Sequence # NMMDS Component Answer ID NMMDS Code
1 Individual LA12070-1 04.02.01
2 Family LA12068-5 04.02.02
3 Population LA12078-4 04.02.03
57122-4 Type of encounter [NMMDS] - Normative answer list (LL769-1)
Sequence # NMMDS Component Answer ID NMMDS Code 1 Patient days – method 1 LA12073-5 04.03.01 2 Patient days – method 2 LA12074-3 04.03.02 3 Patient days – method 3 LA12075-0 04.03.03 4 Patient days – method 4 LA12076-8 04.03.04 5 Patient days – method 5 LA12077-6 04.03.05
6 Visits LA12086-7 04.03.06 7 Consults LA12066-9 04.03.07 8 Contacts LA12067-7 04.03.08 9 Programs LA12080-0 04.03.09 10 Classes LA12065-1 04.03.10 RECOMMENDED CODING
Coding includes combining NMMDS data element, type of nurse provider, type of client, type of encounter, and information about the encounter.
NMMDS Data element Type of nursing provider
Type of client Type of encounter Encounter Details 04 01 APN 02 RN 03 LPN/ LVN 04 UAP 05 Total nursing personnel 01 Individual 02 Family 03 Population
01 Patient Days – Method 1 02 Patient Days – Method 2 03 Patient Days – Method 3 04 Patient Days – Method 4 05 Patient Days – Method 5 06 Visits 07 Consults 08 Contacts 09 Programs 10 Classes 01 Hours/ encounter 02 Encounter Capacity 03 Actual Encounters
RECOMMENDATIONS FOR EACH TYPE OF NURSE PROVIDER There are some combinations type of encounter and type of client that are not logical. The following are the recommended types of clients and encounter types for each type of nurse provider. For each combination, the reporting unit/ service would always report three numbers: hours/ encounter, encounter capacity, and actual encounters.
Certified Advanced Practice Nurse (APN)
Individual Family Population
Patient Days – Method 1 X
Patient Days – Method 2 X
Patient Days – Method 3 X
Patient Days – Method 4 X
Patient Days – Method 5 X
Visits X X X
Consults X X X
Programs X X
Classes X X
Registered Nurse, not APN
Individual Family Population
Patient Days – Method 1 X
Patient Days – Method 2 X
Patient Days – Method 3 X
Patient Days – Method 4 X
Patient Days – Method 5 X
Visits X X X
Consults X X X
Contacts X X X
Programs X X
Classes X X
Licensed Practical/ Vocational Nurse (LPN/ LVN)
Individual Family Population
Patient Days – Method 1 X
Patient Days – Method 2 X
Patient Days – Method 3 X
Patient Days – Method 4 X
Patient Days – Method 5 X
Visits X X X
Contacts X X X
Classes X X
Unlicensed Assistive Personnel (UAP) i.e. nursing assistant or home health aide
Individual Family Population
Patient Days – Method 1 X
Patient Days – Method 2 X
Patient Days – Method 3 X
Patient Days – Method 4 X
Patient Days – Method 5 X
Visits X X X
Contacts X X X
Programs X X
Classes X X
Total Nursing Personnel
Individual Family Population
Patient Days – Method 1 X
Patient Days – Method 2 X
Patient Days – Method 3 X
Patient Days – Method 4 X
Patient Days – Method 5 X
Visits X X X
Consults X X X
Contacts X X X
Programs X X
05 Care Delivery Structure and Outcomes
The ways in which nursing work is organized for a unit or service. Methods differ and are delineated by nursing responsibilities and accountability for how work is planned, delivered, resources allocated, and care coordinated16,17.
05.02 Functional- Nursing care organized and delineated by the specific tasks and technical aspects provided to a group of patients/clients18-21.
05.03 Team- Nursing care organized by a registered nurse who has the authority and accountability for planning, coordinating, and evaluating nursing care for a group of patients/clients and for directing a team of professional and non-professional providers and assistants17-21.
05.04 Total Patient Care - Nursing care organized by registered nurse who has the authority and accountability for assessing, planning, coordinating, delivering, and evaluating nursing care for one or more patients/clients for a work shift17,19,21.
05.05 Primary Nursing - Nursing care organized by a registered nurse who has the authority and accountability for assessing, planning, coordinating, delivering and evaluating nursing care for a group of patients/ clients throughout their length of stay. When not present to provide care, the primary nurse’s (RN’s) responsibility is delegated to associate nursing personnel who implement care according to the care plan devised by the primary nurse 17-19,21.
05.06 Case Management - Nursing care organized by a registered nurse who has the authority and accountability for advocating, assessing, planning, implementing, coordinating, monitoring and evaluating options and services in order to meet client needs to promote care across the continuum, decrease fragmentation and duplication of care, and to enhance quality and cost-effectiveness of care17,22,23.
05.07 Managed Care - “A broad continuum of entities, from the simple requirement of prior authorization for a service in an indemnity health insurance plan to the assumption of all legal, financial, and organizational risks, for the provision of a set of comprehensive benefits to a defined population. Also, the management of
healthcare clinical services supplied by groups of providers with the aims of cost effectiveness, quality, and accessibility”24(p29).
05.09 Advanced Practice Nursing -A model of nursing practice that is provided and/ or directed by an advanced practice nurse with advanced education and national certification such as a certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP) for a specialty population i.e. family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender-related or psych/mental health. (p.6, Accessed 4 April 2009, from
http://www.nursingworld.org/DocumentVault/APRNs/ConsensusModelforAPRN Regulation.aspx)25.
LOINC Coding
LOINC Code NMMDS Component Answer ID NMMDS Code
57127-3 Method of care delivery LL770-9 05
LOINC Answer List
57127-3 Method of care delivery [NMMDS] - Normative answer list for LL770-9.
Sequence # NMMDS Component Answer ID NMMDS Code
1 Functional LA12069-3 05.02
2 Team LA12082-6 05.03
3 Total patient care LA12084-2 05.04
4 Primary nursing LA12079-2 05.05
5 Case management LA12064-4 05.06
6 Managed care LA12072-7 05.07
7 Advanced practice nursing LA12062-8 05.09
06 Patient/Client Accessibility
The time, distance and method to connect the nurse/provider and client for an encounter and includes the information, supplies, equipment and personnel required for the encounter. Glossary of Terms in Revised NMMDS Element 6:
Method - The way of connecting for a provider-client encounter (e.g., walking, driving, telephone, email, etc.) or types of procedures/processes used to connect with clients (e.g., synchronous or asynchronous communications).
Encounter - An interaction between a provider and a client for the direct provision of health care service(s).
Essential Resources - Information, supplies, equipment and personnel resources needed for a client encounter.
Information - Facts, opinions, or algorithms that are capable of being transmitted or reproduced and reduce uncertainty
Supplies - Consumable items used for health related interventions. These may be located on a care unit or may require delivery (e.g. blood, durable medical equipment).
Equipment - Devices that can be used repeatedly for a health related purpose (e.g., blood pressure cuff, oxygen delivery system, bed, etc.).
Personnel - Nursing personnel who provide direct or indirect services that support provision of care during a client encounter. Personnel now are defined as nursing personnel but in the future this could include other personnel (e.g. physicians, nurses, occupational therapists, transport personnel, unit secretaries, etc.).
* Note, previous measures were discontinued for this NMMDS data element.
06.07 Average time (in minutes) to access the client per encounter 06.08 Average distance required to travel for an encounter
06.09 Method used to connect with client for an encounter (select all that apply)
06.09.01 walking.
06.09.02 motorized vehicle.
06.09.03 nonmotorized vehicle (i.e. bicycle).
06.09.04 asynchronous electronic communication e.g., email or blogging. 06.09.05 synchronous communication e.g., telephone, telehealth video visit. 06.09.06 monitoring the client from the nurses’ station e.g., remote camera monitoring.
06.09.07 monitoring the client observing in client(s) room e.g., sitting in client room.
06.11 Average distance (in meters) required to gather essential resources for an encounter.
LOINC Coding
LOINC Code NMMDS Component Data Type NMMDS Code
77548-6 Client accessibility panel [NMMDS] 06
77549-4 Time to access a patient [NMMDS] min 77550-2 Time to access all patients in a Report Period
[NMMDS]
min 77551-0 Total number of patient encounters in a
reporting period [NMMDS]
{#} 77552-8 Average time to access a patient in a Report
Period [NMMDS]
min 06.07
77553-6 Distance to access a patient [NMMDS] m 77554-4 Distance to access all patients in a Report
Period [NMMDS]
m 77555-1 Average distance to access a patient in a
Report Period [NMMDS]
m 77556-9 Method used to connect with a patient
[NMMDS]
06.09
77557-7 Time required to gather essential resources for a patient encounter [NMMDS]
min 06.10
77558-5 Time required to gather essential resources for all patient encounters in a Report Period [NMMDS]
min
77559-3 Average time required to gather essential resources for a patient encounter in a Report Period [NMMDS]
min
77560-1 Distance required to gather essential
resources for a patient encounter [NMMDS] m 77561-9 Distance required to gather essential
resources for all patient encounters in a Report Period [NMMDS]
m
77562-7 Average distance required to gather essential resources for a patient encounter in a Report Period [NMMDS]
m 06.11
LOINC Answer List
77556-9 Method used to connect with a patient [NMMDS] - Normative answer list for LL3621-1.
Sequence # NMMDS Component Answer ID NMMDS Code
2 Motorized vehicle LA24006-1 06.09.02 3 Nonmotorized vehicle (e.g. bicycle) LA24007-9 06.09.03 4 Asynchronous electronic communication
(e.g., email, blogging)
LA24008-7 06.09.04 5 Synchronous communication (e.g., telephone,
telehealth video visit)
LA24009-5 06.09.05 6 Monitoring from the nurses’ station (e.g.,
remote camera monitoring)
LA24010-3 06.09.06 7 Monitoring in the client(s) room (e.g., sitting
in client room)
LA24011-1 06.09.07
10 Accreditation/Certification/Licensure
Indicate quality assurance organizations of the nursing delivery unit/service by 3 different quality measure categories. Use all that apply.
Accreditation - Accreditation is a seal of approval given by private, nationally recognized groups that check on the quality of care at health care facilities and organizations. Health care organizations must meet certain quality standards in order to be accredited26.
Certification- Certification is the formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards that are identified by the profession (ANA, 2009)27.
Licensure - Licensure is the granting of authority to practice (ANA, 2009)27. State agencies determine the requirements for licensure and examine the competency necessary to meet quality standards.
10.03 Accreditation
10.03.01 The Joint Commission Accreditation28
10.03.02 Accreditation Association for Ambulatory Health Care (AAAHC)29
10. 03.03 Accreditation Commission for Health Care, Inc. (ACHC)30
10. 03.04 American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)31
10. 03.05 American Osteopathic Association (AOA) Accreditation Program32
10. 03.06 Healthcare Facilities Accreditation Program (HFAP)33
10. 03.07 Community Health Accreditation Program (CHAP)34
10.04 Certification
10.04.01 The Joint Commission Certification28
10.04.02 DNV (Det Norske Veritas) Healthcare Accreditation Program35
10.04.03 Medicare Certification 10.05 Licensure
10.05.01 State Licensure LOINC Coding
LOINC Code NMMDS Component Answer ID NMMDS Code
75533-0 NMMDS accreditation, certification, and licensure panel
10
75533-0 Applicable accrediting agency for unit LL3062-8 10.03
75534-8 Accreditation received LL3062-8
75536-3 Applicable certification agency for unit 10.04 75535-5 Certification received
75537-1 Applicable licensing agency for unit LL3064-4 10.05
75538-9 Licensing received LL3064-4
LOINC Answer List
75533-0 Applicable accrediting agency for unit [NMMDS] - Normative answer list for LL3062-8
75534-8 Accreditation received [NMMDS] - Normative answer list for LL3062-8
Sequence # NMMDS Component Answer ID NMMDS Code
1 The Joint Commission Accreditation LA21572-5 10.03.01 2 Accreditation Association for Ambulatory
Health Care
LA21573-3 10.03.02 3 Accreditation Commission for Health Care, Inc. LA21574-1 10.03.03 4 American Association for Accreditation of
Ambulatory Surgery Facilities (AAAASF)
LA21575-8 10.03.04 5 American Osteopathic Association (AOA)
Accreditation Program
LA21576-6 10.03.05 6 Healthcare Facilities Accreditation Program
(HFAP)
LA21577-4 10.03.06 7 Community Health Accreditation Program
(CHAP)
LA21578-2 10.03.07 8 DNV Healthcare (DNVHC) Accreditation
Program
75536-3 Applicable certification agency for unit [NMMDS] - Normative answer list for LL3062-8
75535-5 Certification received [NMMDS] - Normative answer list for LL3062-8:
Sequence # NMMDS Component Answer ID NMMDS Code 1 The Joint Commission Certification LA21580-8 10.04.01 2 DNV (Det Norske Veritas) Healthcare
Certification
LA21581-6 10.04.02
2 Medicare Certification LA21582-4 10.04.03
75537-1 Applicable licensing agency for unit [NMMDS] - Normative answer list for LL3064-4 75538-9 Licensing received [NMMDS] - Normative answer list for LL3064-4
Sequence # NMMDS Component Answer ID NMMDS Code
1 State Licensure LA21584-0 10.05.01
COMPONENT - NURSE RESOURCES 13 Staffing
The quantity, turnover and retention of nurse staffing by direct care and management position on a nursing delivery unit/service for a reporting period (dd/mm/yy). For this survey, “New Nursing Staff” is any nurse that starts a new job position.
13.07 Nursing Staff Job Positions -The nursing staff position on a unit or service during the reporting period
13.07.01 Direct Care Staff: The direct care staff positions on a unit or service during the reporting period (dd/mm/yy)
13.07.01.01 Advanced Practice Nurses
13.07.01.02 Registered Nurses reporting to department of nursing
13.07.01.03 Licensed Practical Nurses/Licensed Vocational Nurses reporting to department of Nursing
13.07.01.04 Nurse Aids or Equivalent extenders 13.07.01.05 Nursing Students
13.07.01.06 Agency/Travelers Staff
13.07.02 Management, Administrative, Support Staff: The management, administrative, or support staff on a unit or service during the reporting period
13.07.02.01 Case Manager 13.07.02.02 Nurse Manager
13.07.02.03 Staff Development/ Educators 13.07.02.04 Researchers
13.07.02.05 Nursing Quality Improvement (QI) Staff
13.07.02.06 Support Staff (e.g. unit clerks, environmental aids, techs)
13.04 Nursing Staff Quantity- The number of staff, number of full time equivalents (FTE) hours, and average daily productive staff by position.
13.04.01 Number of Actual Staff -The number of total staff actually working by
