CHAPTER 16: NURSING MINIMUM DATA SET SYSTEMS

INTRODUCTION: Clinical nursing visibility from national to international contexts. The identification of the NMDS visionary work begun in the United States in 1980s by Werly and Lang (1988), has indeed spurred activity extending to national efforts to develop similar data sets around the world. Moreover, these national efforts have supported an initiative to develop an international i-NMDS.

NMDS HISTORICAL SUMMARY:  The NMDS identifies essential, common, and core data elements to be collected for all patients/ clients receiving nursing care.  NMDS- is a standardized approach that facilitates the abstraction of these minimum, common, essential core data elements to describe nursing practice from both paper and electronic records. - it is intended for use in all settings where nurses provide care, spanning  the NMDS was conceptualized through a small group work at the nursing information systems (NISs) conference held at the University of Illinois College of nursing.  Werly and colleagues took the NMDS forward at the NMDS conference held at the University of Wisconsin- Milwaukee School of Nursing.  It was during this invitational conference that the NMDS was developed consensually through the efforts of 64 conference participants and formalized by Werly and Lang, 1988.

THREE BROAD CATEGORIES OF ELEMENTS OF NMDS  A. Nursing Care  B. Patients or client demographics  C. Service Elements

NURSING CARE ELEMENTS:  Nursing Diagnosis  Nursing Intervention  Nursing Outcome  Intensity of nursing care

PATIENT OR CLIENT DEMOGRAPHIC ELEMENTS:  Personal Identification  Date of birth  Sex  Race and ethnicity  Residence

SERVICE ELEMENTS:  Unique facility or service agency number  Unique health record number of patient or client  Unique number of principle registered nurse provider  Episode admission or encounter date  Discharge or termination date  Disposition of patient or client  Expected payer for most of this bill ( anticipated financial guarantor for services).

 Aim of the NMDS- is not to be redundant of other data sets, but rather to identify what are the minimal data needed to be collected from records of patients receiving nursing care.  The NMDS- was developed by building on the foundation established by the U.S uniform hospital discharge data set (UHDDS)

EIGHT BENEFITS OF THE NMDS  Access to comparable, minimum nursing care, and resources data on local, regional, national, and international levels.  Enhance documentation of nursing care provided.  Identification of trends related to patient or client problems and nursing care provided.  Impetus to improved costing of nursing services.  Improve data for quality assurance evaluation.  Impetus to further development and refinement of NISs.  Comparative research on nursing diagnoses, nursing interventions, nursing outcomes, intensity of nursing care, and referral for further nursing services.  Contribution toward advancing nursing as a research-based discipline.

STANDARDS AND RESEARCH ERA- 21 ST CENTURY:  The NMDS influenced the work of the professional nurses association (ANA) recognized the NMDS as the minimum data elements to be included in any data set or patient record.  The ANA consequently established the American nurses association steering committee on data bases to support clinical nursing practice.  This committee launched a recognition process for standardized nursing vocabularies needed to capture the NMDS data elements for nursing diagnoses, interventions, and outcomes in a patient record.

11 LANGUAGES HAVE BEEN RECOGNIZED BY ANA 2004 AND TWO DATA SETS: LANGUAGES:  ABC codes  Clinical care classification (ccc) (formerly home health care classification)  International classification for nursing practice ( ICNP)  Logical observation identifiers names and codes ( LOINC)  NANDA- nursing diagnoses, definition, and classification  Nursing outcomes classification (NOC)  Nursing interventions classification (NIC) system  Omaha System  Patient care data set (PCDS)  Perioperative Nursing data set (PNDS)

DATA SETS: o Nursing minimum data set (NMDS) o Nursing management minimum data set (NMMDS)

 The NMDS- serves as a key component of the standards developed by the nursing information & data set evaluation center (NIDSEC)  NIDSEC develops and disseminates standards related to nomenclature, clinical associations, clinical data repositories, and system characteristics/ decision support/ contextual variables pertaining to data sets in information systems that support the documentation of nursing practice.

NATIONAL NURSING MINIMUM DATA SETS: Established NMDS: the early NMDS work in the United States spurred the development of NMDS in numerous other countries. To data seven countries have identified NMDS system 1. Australia 2. Canada 3. Belgium 4. Iceland 5. Netherlands 6. Switzerland 7. Thailand

EMERGENT NMDS: Several countries across most continents beyond north America are exploring development of NMDS system. Work is ongoing in the United Kingdom, to identify NMDS to be congruent with the initiatives of the national health service.

CALL FOR STANDARDIZED CONTEXTUAL DATA:  Ample studies have demonstrated the significance of nurse staffing, patients/ staff ratios, professional autonomy and control, organizational characteristics, unit internal environment, coordination/ collaboration, and educational level on the quality and outcomes of patient care. These studies have influenced the identification and use of NMDS elements.

NMDS AND DATA ELEMENTS:  Environment: Unit/ cost center identifier Type Patient/ client population Volume Accreditation Organizational decision making power Environmental complexity Patient/ client accessibility Method of care delivery Clinical decision making complexity

 Nursing Care: Management demographic profile Staffing Staff demographic profile staff satisfaction  Financial Resources: Payer type reimbursement Budget Expense

NMDS RELATIONSHIP TO INTERNATIONAL NURSING MINIMUM DATA SET (I-NMDS) Evolution of concepts: The i-NMDS includes core internationally relevant, essential, minimum data elements to be collected in the course for providing nursing care. These data can provide information to describe, compare, and examine nursing practice around the globe. i-NMDS- is intended to build on the efforts already underway in individual countries. It is imperative that the national health care infrastructure supports the collection and reuse of nursing data.

PURPOSES: The contribution of nursing care and nurses is essential to health care globally. The i-NMDS as a key data set will support:  Describing the human phenomena, nursing interventions, care outcomes, and resource consumption related to nursing services.  Improving the performance of healthcare systems and the nurses working within these systems worldwide.  Enhancing the capacity of nursing and midwifery services  Testing evidenced-based practice improvements  Addressing the nursing shortage, inadequate working conditions, poor distribution and inappropriate utilization of nursing personnel, and the challenges as well as opportunities of global technological innovations.  Empowering the public internationally.