implementation guide for loinc® coding the nursing ... · focus group composed by nursing...

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Updated August 17, 2016

Implementation Guide for LOINC® Coding the Nursing Management Minimum

Data Set: NMMDS©

October 2015

Sponsored by:

Center for Nursing Informatics

School of Nursing – University of Minnesota

Copyright © 2015 Connie W. Delaney (Original Copyright © 1996 by Diane Huber/Connie

Delaney – A Nursing Managemnt Minimum Data Set (NMMDS): A Report of an Invitational

Conference).

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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 ........................................................................................................................... 47

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

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APPENDIX A – The Nursing Management Minimum Data Set Survey ..................................... 75

APPENDIX B - Publications - NMMDS Articles Published ....................................................... 99

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

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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.

http://en.wikipedia.org/wiki/Electronic_health_record

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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

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

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Amar Subramanian

Dorcas Kunkel

Mary Jo Swanson

[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

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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.

Figure 1: Use Case for the integration of the NMMDS data elements into information system

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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).

Figure 2: Hierarchy of the NMMDS data elements by high level categories

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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.

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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).

http://loinc.org/

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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.

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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

https://nppes.cms.hhs.gov/NPPES/Welcome.do

https://nppes.cms.hhs.gov/NPPES/Welcome.do

http://zip4.usps.com/zip4/citytown_zip.jsp

http://www.cms.hhs.gov/PlaceofServiceCodes/Downloads/placeofservice.pdf

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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

http://www.nursingquality.org/Documents/Public/APPENDIX%20D.pdf



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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

02.04.05.02 Adult Neuro/Neurosurgery Med-Surg Combination Unit

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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

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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

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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

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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

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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

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LOINC Coding


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

21


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

22


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

LA10237-8 02.04.24.01

97 Adolescent Intensive Psychiatric Inpatient LA10238-6 02.04.24.02

23


Unit

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

LA10262-6 02.04.30.02

122 Multiple Psychiatric Unit Types Mixed

Acuity Inpatient Unit

LA10263-4 02.04.30.03

24


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

163 Genetics/Genetics Counseling Clinic LA10304-6 02.04.36.11

164 Health Promotion Clinic LA10305-3 02.04.36.12

165 Infection Control Clinic LA10306-1 02.04.36.13

25


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

http://www.seer.cancer.gov/stdpopulations/stdpop.19ages.html



26


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

03.02

52861-2 Catchment area panel population % for each

catchment

03.03

27


group

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
















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

28


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 encounter is 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

29


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.

30


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

31


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)


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)


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)


1 Patient days – method 1 LA12073-5 04.03.01





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 Type of Type of client Type of encounter Encounter

32


Data

element

nursing

provider

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





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





Visits X X X

Consults X X X

Contacts X X X

Programs X X

Classes X X

33


Registered Nurse, not APN







Visits X X X

Consults X X X

Contacts X X X

Programs X X

Classes X X

Licensed Practical/ Vocational Nurse (LPN/ LVN)







Visits X X X

Contacts X X X

Programs X X

Classes X X

Unlicensed Assistive Personnel (UAP) i.e. nursing assistant or home health aide

34








Visits X X X

Contacts X X X

Programs X X

Classes X X

Total Nursing Personnel







Visits X X X

Consults X X X

Contacts X X X

Programs X X

Classes X X

35


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).

36


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.


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).

http://www.nursingworld.org/DocumentVault/APRNs/ConsensusModelforAPRNRegulation.aspx




37


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.

06.10 Average time (in minutes) required to gather essential resources for an encounter

06.11 Average distance (in meters) required to gather essential resources for an

encounter.

LOINC Coding

38



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.


1 Walking LA11834-1 06.09.01

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, LA24009-5 06.09.05

http://r.details.loinc.org/LOINC/77548-6.html?sections=Comprehensive















39


telehealth video visit)

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. 03. 08 DNV Healthcare (DNVHC) Accreditation Program35

10.04 Certification

10.04.01 The Joint Commission Certification28

10.04.02 DNV (Det Norske Veritas) Healthcare Accreditation Program35

40


10.04.03 Medicare Certification

10.05 Licensure

10.05.01 State Licensure

LOINC Coding


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


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

10.03.08

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:

41



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


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

13.07.01.07 Independent Contractors/ Sub-contractors

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

42


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

position during the reporting period (dd/mm/yy).

13.04.02 FTEs of Actual Staff - The number of full time equivalent (FTE) hours

of total staff actually working by position during the reporting period

(dd/mm/yy). An FTE is equivalent 2080 hours per year which includes

any paid time, for example - hours working, vacation, sick time, leave of

absence or other paid activity.

13.04.03 Number of Budgeted Staff - The number of total staff budgeted by

position during the reporting period (dd/mm/yy).

13.04.04 FTEs of Budgeted Staff -The number of full time equivalent (FTE) hours

of total staff budgeted by position during the reporting period

(dd/mm/yy). An FTE is equivalent 2080 hours per year which includes

any paid time, for example - hours working, vacation, sick time, leave of

absence or other paid activity.

13.04.05 Productive staff - All staff available for care/service provision,

excluding e.g.: vacation, disability, or any other type of paid time off.

13.04.06 Number of New Nurses by Job position - the number of new nursing

staff by job position hired during the reporting period

13.04.07 Number of New Nurses by Job Position who remained – the number of

new nurses hired during the reporting period who remained at the end

of the reporting period

43


13.04.08 Number of New Nurses by Job Position who left - the number of new

nurses hired during the reporting period who left by the end of the

reporting period

13.04.09 Number of Nursing Staff by Position at Beginning of reporting period –

Nursing staff by job position at the beginning of the reporting period –

these are considered preexisting staff and does not include newly hired

staff during the reporting period

13.04.10 Number of Nursing Staff at Beginning of the reporting by Position who

remained (preexisting staff)

13.04.11 Number of Nursing Staff at Beginning of the reporting period by

Position who left (preexisting staff)

13.04.12 Number of Nursing Staff by Position who left. It includes both voluntary

and involuntary turnover for newly hired and preexisting staff by job

position. (13.04.08 + 13.04.11)

13.04.13 Average Number of Nursing Staff by Position in a Unit or Service. It is

obtained by adding the nurses by position at the beginning and end of

the period (dd/mm/yy) and dividing by two.

13.04.14 Number of Nursing Staff Positions that are unfilled

13.05 Nursing Staff Turnover - Turnover is the percent of nurses by position who are

leaving a unit or service either voluntarily or involuntarily.

13.05.01 Voluntary Turnover36 - The percent of nurses by position assigned to a

unit or service during the reporting period (dd/mm/yy) who self-report a

personal choice to transfer or terminate. It includes both full and part

time nurses. It excludes terminations due to death, illness, or turnover

due to organizational reasons rather than individual reasons.

13.05.01.01 Transfer Voluntary Turnover - The percent of nurses by

position assigned to a unit or service during the reporting

period (dd/mm/yy) who self-report choosing to transfer.

44


13.05.01.02 Terminate Voluntary Turnover - The percent of nurses by

position assigned to a unit or service during the reporting

period (dd/mm/yy) who self-report choosing to terminate.

13.05.02 Involuntary Turnover - The percent of nursing staff by type of job

position who leave from a unit or service due to illness, death, or

organizational decisions including promotions, layoffs, transfers,

dismissals, or involuntary retirements. It includes both full and part

time nurses.

13.05.03 Turnover rate37 - The percent of nursing staff by position who left the

unit or service during a reporting period (dd/mm/yy). The number of

staff who left includes both voluntary and involuntary turnover. The

calculation is based on the number of staff assigned to the unit during

the reporting period.

Number of Nurses by Position who left (13.04.12)

Average Number of Nurses by Position in a Unit or Service (13.04.13) × 100

13.05.04 Vacancy rate - The percent of positions that are unfilled by nursing

staff job position divided by the total number of positions budgeted

during the reporting period (dd/mm/yy).

Number of Nurse Positions that are unfilled (13.04.14)

Average Number of Nurses by Position in a Unit or Service (13.04.13) × 100

13.05.05 Number of Budgeted Positions Filled

13.06 Nursing Staff Retention

13.06.01 Accession Rate37 - The percent (%) of new nursing staff by job position

who stayed during a specified period of time. It is the number of new

nursing staff by job position added during the reporting period

(dd/mm/yy) divided by the average number of nurses by position in a

unit or service.

Number of New Nurses by Position (13.04.06)

Average Number of Nurses by Position in a Unit or Servive (13.04.13) × 100

45


13.06.02 Stability Rate37 - The percent (%) of nursing staff employed by position

at the beginning of the period (dd/mm/yy) and who still stayed at the end

of the period (dd/mm/yy). It is calculated by dividing the number of

beginning nurses remaining by position during the reporting period

(dd/mm/yy) by the total number of nurses by position at the start of the

period (dd/mm/yy).

Number of Beginning Nurses by Position who remained (13.04.10)

Number of Nurses by Position at Beginning (13.04.09) × 100

13.06.03 Instability Rate37 - The percent (%) of nursing staff employed by

position at the beginning of the period (dd/mm/yy) but who left at the

end of the period of time (dd/mm/yy). It is calculated by the number of

new nursing staff by job position leaving during the reporting period

(dd/mm/yy) by the number of new nursing staff by job position at the

start of the reporting period (dd/mm/yy).

Number of Beginning Nurses by Position who left (13.04.11)

Number of Nurses by Position at Beginning (13.04.09) × 100

13.06.04 Survival Rate37 - The percent (%) of newly hired nurses who remained

during a reporting period (dd/mm/yy). It is calculated by dividing the

number of new nursing staff by job position remaining during the

reporting period (dd/mm/yy) divided by the number of new nurses by

position.

Number of New Nurses by Position who remained (13.04.07)

Number of New Nurses by Position (13.04.06) × 100

13.06.05 Wastage Rate37 - The percent (%) of newly hired nurses who left during

a specified period of time (dd/mm/yy). It is calculated by dividing the

number of new nurses by position leaving by the number of new nurses

by position.

Number of New Nurses by Position who left (13.04.08)

Number of New Nurses by Position (13.04.06) × 100

LOINC Coding


46


77255-8 Nursing staff job positions, quantity, turnover,

and retention panel [NMMDS]

13

77284-8 Nursing staff job positions panel [NMMDS] 13.07

77286-3 Direct care staff [NMMDS] 13.07.01

77287-1 Management, administrative, AndOr support

staff [NMMDS]

13.07.02

77256-6 Nursing staff quantity panel [NMMDS] 13.04

77257-4 Number of actual nursing staff by job position

in a reporting period [NMMDS]

{#} 13.04.01

77258-2 Full time equivalent hours of actual nursing

staff [NMMDS]

h 13.04.02

77259-0 Number of budgeted nursing staff by job

position in a reporting period [NMMDS]

{#} 13.04.03

77260-8 Full time equivalent hours of budgeted

nursing staff [NMMDS]

h 13.04.04

77263-2 Number of productive staff in a reporting

period [NMMDS]

{#} 13.04.05

77264-0 Number of new nursing staff by job position


{#} 13.04.06


who remained in a reporting period

[NMMDS]

{#} 13.04.07


who left in a reporting period [NMMDS]

{#} 13.04.08

77267-3 Number of nursing staff by job position at

beginning of a reporting period [NMMDS]

{#} 13.04.09


beginning of a reporting period who remained

[NMMDS]

{#} 13.04.10


beginning of a reporting period who left

[NMMDS]

{#} 13.04.11

77270-7 Number of nursing staff by job position who

left in a reporting period [NMMDS]

{#} 13.04.12

77271-5 Average number of nursing staff by job

position in a reporting period [NMMDS]

{#} 13.04.13

77272-3 Number of unfilled nursing staff job positions


{#} 13.04.14

77273-1 Nursing staff turnover panel [NMMDS] 13.04

77262-4 Nursing staff.voluntary turnover/Nursing staff

[NMMDS]

% 13.05.01

77261-6 Nursing staff.voluntary turnover.transfer/

Nursing staff [NMMDS]

% 13.05.01.01

77274-9 Nursing staff.voluntary turnover.terminate/


% 13.05.01.02

77275-6 Nursing staff.involuntary turnover/Nursing % 13.05.02

























47


staff [NMMDS]

77276-4 Turnover rate [NMMDS] % 13.05.03

77277-2 Vacancy rate [NMMDS] % 13.05.04

77278-0 Number of budgeted nursing staff job

positions filled in a reporting period

[NMMDS]

{#} 13.05.05

77279-8 Nursing staff retention panel [NMMDS] 13.06

77280-6 Accession rate [NMMDS] % 13.06.01

77281-4 Stability rate [NMMDS] % 13.06.02

77282-2 Instability rate [NMMDS] % 13.06.03

77283-0 Survival rate [NMMDS] % 13.06.04

77285-5 Wastage rate [NMMDS] % 13.06.05

LOINC Answer List

77286-3 Direct care staff [NMMDS] - Normative list for LL3589-0.


1 Advanced Practice Nurses LA23763-8 13.07.01.01

2 Registered Nurses reporting to department of

nursing

LA23764-6 13.07.01.02

3 Licensed Practical Nurses/Licensed Vocational

Nurses reporting to department of nursing

LA23765-3 13.07.01.03

4 Nurse Aids or Equivalent extenders LA23766-1 13.07.01.04

5 Nursing Students LA23767-9 13.07.01.05

6 Agency/Travelers Staff LA23768-7 13.07.01.06

7 Independent Contractors/ Sub-contractors LA23769-5 13.07.01.07

77287-1 Management, administrative, AndOr support staff [NMMDS] – Normative answer list

for LL390-8


1 Case Manager LA23770-3 13.07.02.01

2 Nurse Manager LA23771-1 13.07.02.02

3 Staff Development/ Educators LA23772-9 13.07.02.03

4 Researchers LA23773-7 13.07.02.04

5 Nursing Quality Improvement (QI) Staff LA23774-5 13.07.02.05

6 Support Staff (e.g. unit clerks, environmental

aids, techs)

LA23775-2 13.07.02.06

14 Satisfaction

Reporting period - dates satisfaction survey completed are within the reporting period

(dd/mm/yy) (See NMMDS 1)










48


Facility – this is the highest level of aggregation of reporting in which one or many units may

report to a facility (See NMMDS 1)

Unit – this is the level of analysis used in the NMMDS (See NMMDS)

Nursing job class:

1. Direct Care Staff

2. Management

3. Administrative

4. Support Staff

Job satisfaction survey – if the facility has a job satisfaction survey, questions should be mapped

to these 10 items. If not, then it is suggested using this survey. The job satisfaction variable is

captured in the facility data base indicating that the survey was mapped or added as a record to a

staff person during the reporting period (dd/mm/yy).

Satisfaction survey questions – this would include each of the 10 questions in the survey and the

answer to the question ranging from 1 – 5. The satisfaction items were adapted from Hackman

and Oldham’s General Job Satisfaction measures from the Job Diagnostic Survey (JDS)38,39.

Scale: 1=strongly disagree; 2=disagree; 3=neutral; 4=agree; 5=strongly agree

14.11.01 Generally speaking, I am very satisfied with this job.

14.11.02 I rarely think of quitting this job.

14.11.03 I am generally satisfied with the kind of work I do in this job.

14.11.04 Most nursing staff on this job are very satisfied with the job.

14.11.05 Nursing staff on this job rarely think of quitting.

14.21.01 Generally speaking, I am very satisfied with nursing management.

14.21.02 Generally speaking, I am very satisfied with nursing administration.

14.21.03 Generally speaking, I am very satisfied with interactions with

physicians.

14.21.04 Generally speaking, I am very satisfied with interactions with non-

physician health care team members.

14.21.05 Generally speaking, I am very satisfied with my own level of

autonomy.

49


14.03 Total number staff taking survey

LOINC Coding

LOINC Code NMMDS Component Answer ID NMMDS code

74182-7 NMMDS job satisfaction panel Panel

74183-5 Nursing job class [NMMDS] Panel

74181-9 Generally speaking, I am very satisfied with

this job

LL2712-9 14.11.01

74180-1 I rarely think of quitting this job LL2712-9 14.11.02

74179-3 I am generally satisfied with the kind of work I

do in this job

LL2712-9 14.11.03

74178-5 Most nursing staff on this job are very satisfied

with the job

LL2712-9 14.11.04

74177-7 Nursing staff on this job rarely think of quitting LL2712-9 14.11.05


nursing management

LL2712-9 14.22.01


nursing administration

LL2712-9 14.21.02


interactions with physicians

LL2712-9 14.21.03


interactions with non-physician health care

team members

LL2712-9 14.21.04

74172-8 Generally speaking, I am very satisfied with my

own level of autonomy

LL2712-9 14.21.05

74171-0 Total number of staff completing the job

satisfaction survey

LL2712-9 14.03

LOINC Answer List

74182-7 NMMDS job satisfaction panel - Normative answer list for LL2712-9


1 Strongly disagree LA15236-5 1

2 Disagree LA15773-7 2

3 Neutral LA14786-0 3

4 Agree LA15774-5 4

5 Strongly agree LA15237-3 5

Instructions

The normative answer list is used for all satisfaction questions.

The percent of staff for each of the satisfaction questions can be calculated by either all staff

assigned to a unit or by job class for a specified reporting period (dd/mm/yy). The denominator















http://r.details.loinc.org/AnswerList/LL2712-9.html

50


is the total number of staff assigned to a unit during the reporting period or the total number of

staff by job class. The numerator is the number of staff by each satisfaction question either for

the total unit or by job class.

19 Nurse Demographics per Unit or Service

NMMDS 19 includes the demographics and profiles of the nursing personnel on a unit or in a

place of service. NMMDS 19 replaces the previous NMMDS 11 and NMMDS 1240.

19.01 Employment position41,42 - Percent of staff on a nursing unit or service line with

primary job title with assigned responsibilities.

19.01.01 Advanced Practice Registered Nurse (APRN) - A registered nurse

(RN) who has a graduate degree and advanced knowledge including

nurses with masters or doctoral degrees

19.01.02 Advanced Practice Nurse (APN) – An RN who has a graduate degree

with a specific specialty (Nurse Practitioner, Certified Registered

Nurse Anesthetist, Certified Nurse-Midwife and Clinical Nurse

Specialist, or other graduate specialties) and may be licensed and or

certified to practice nursing at an advanced level with substantial

autonomy and independence and a high level of accountability.

19.01.03 Nurse Consultant (NC) - An RN who provides advice or expertise in

the field of nursing regarding such issues as nursing education, nurse

staffing, nurse policy, etc.

19.01.04 Nurse Researcher (NR) - An RN who conducts research in the field of

nursing.

19.01.05 Nurse Executive (NE) - An RN involved with management and

administration concerns.

19.01.06 Nurse Manager (NM) - A nurse who has line management position

with 24-hour accountability for a designated patient care services

which may include operational responsibility for patient care delivery,

fiscal and quality outcomes.

51


19.01.07 Nurse Faculty (NF) - A RN employed by a school of nursing or other

type of nursing education program; nurse faculty are generally

involved in teaching, research and service

19.01.08 Staff Nurse (SN) - A nurse in direct patient care who is responsible for

the treatment and well-being of patients

19.02 Gender43 - The behavioral, cultural, or psychological traits typically associated

with one sex. Percent of licensed staff on a nursing unit or service line

by gender (see 19.08 for license type).

19.02.01 Female

19.02.02 Male

19.02.03 Unknown

19.03 Race/Ethnicity44 – A class or kind of people unified by shared interests, habits,

or characteristics or a category of humankind that shares certain distinctive

physical traits. Percent of licenses staff on a nursing unit or service line by race/

ethnicity (see 19.08 for license type)

19.03.01 American Indian/Alaska Native

19.03.02 Asian

19.03.03 Black/African American

19.03.04 Native Hawaiian/Other Pacific Islander

19.03.05 White/Caucasian

19.03.06 Hispanic/Latino

19.04 Age of Staff - Age by five-year increments of staff member at the start of the

reporting period (See NMMDS 01.11 for reporting period) Percent of licenses

staff on a nursing unit or service line by age (see 19.08 for license type)

19.04.01 15-19 years old

19.04.02 20-24 years old

19.04.03 25-29 years old

19.04.04 30-34 years old

19.04.05 35-39 years old

52


19.04.06 40-44 years old

19.04.07 45-49 years old

19.04.08 50-54 years old

19.04.09 55-59 years old

19.04.10 60-64 years old

19.04.11 65-69 years old

19.04.12 70-74 years old

19.04.13 75+ years old

19.05 Entry Level Nursing Degree - The degree a nurse first completes to enter into

nursing practice.

19.05.01 Licensed Practical /Licensed Vocational degree- Nursing

19.05.02 Associate degree- Nursing

19.05.03 Diploma- Nursing

19.05.04 Baccalaureate degree- Nursing

19.05.05 Master's degree- Nursing

19.05.06 Doctoral degree- Nursing Practice (DNP)

19.05.07 Doctoral degree- Nursing (PhD)

19.05.08 Doctoral degree- Nursing, Other

19.06 Highest Level of Education in a Nursing Degree - The highest level of education

in a nursing degree.

19.06.01 Licensed Practical Licensed Vocational degree- Nursing

19.06.02 Associate degree- Nursing

19.06.03 Diploma- Nursing

19.06.04 Baccalaureate degree- Nursing

19.06.05 Master's degree- Nursing

19.06.06 Doctoral degree- Nursing Practice (DNP)

19.06.07 Doctoral degree- Nursing (PhD)

19.06.08 Doctoral degree- Nursing, Other

53


19.07 Highest Level of Education in Non-Nursing Degree - The highest level of

education in non-nursing degree obtained by a nurse in a non-nursing field.

19.07.01 Associate degree - Non-Nursing

19.07.02 Baccalaureate degree - Non-Nursing

19.07.03 Master's degree- Non-Nursing

19.07.04 Doctoral degree- Non-Nursing

19.08 Nursing License Type

19.08.01 Licensed Practical Nurse or Licensed Vocational Nurse (LPN/LVN)

-An individual who holds a current license to practice as a practical or

vocational nurse in at least one state with jurisdiction of the United

States

19.08.02 Registered Nurse (RN) - An individual who holds a current license to

practice within the scope of professional nursing in at least one

jurisdiction of the United States

19.08.03 Advanced Practice RN - Includes all advanced license statuses for

your state

19.09 Nursing Certification45-47 - A process of verifying that an RN, who through a

formal post-basic education program has developed expertise within a specialty

area of nursing practice. Certification is conducted by an independent and

unbiased credentialing testing center.

19.09.01 Acute Care NP

19.09.02 Adult NP

19.09.03 Adult Psychiatric-Mental Health NP

19.09.04 Adult-Gerontology Acute Care NP

19.09.05 Adult-Gerontology Primary Care NP

19.09.06 Diabetes Management- Advanced

19.09.07 Family NP

19.09.08 Family Psychiatric- Mental Health NP

19.09.09 Gerontological NP

54


19.09.10 Pediatric NP

19.09.11 School NP

19.09.12 Adult- Gerontology CNS

19.09.13 Adult Health CNS

19.09.14 Adult Psychiatric- Mental Health CNS

19.09.15 Child/ Adolescent Psychiatric- Mental Health CNS

19.09.16 Gerontological CNS

19.09.17 Home Health CNS

19.09.18 Pediatric CNS

19.09.19 Public/ Community Health CNS

19.09.20 Ambulatory Care Nursing

19.09.21 Cardiac Rehabilitation Nursing

19.09.22 Cardiac- Vascular Nursing

19.09.23 Certified Vascular Nurse

19.09.24 College Health Nurse

19.09.25 Community Health Nursing

19.09.26 General Nursing Practice

19.09.27 Gerontological Nursing

19.09.28 High- Risk Perinatal Nursing

19.09.29 Home Health Nursing

19.09.30 Informatics Nursing

19.09.31 Medical- Surgical Nursing

19.09.32 Nurse Executive

19.09.33 Nurse Executive, Advanced

19.09.34 Nursing Case Management

19.09.35 Nursing Professional Development

19.09.36 Pain Management Nursing

19.09.37 Pediatric Nursing

55


19.09.38 Perinatal Nursing

19.09.39 Psychiatric- Mental Health Nursing

19.09.40 Public Health Nursing- Advanced

19.09.41 School Nursing

19.09.42 CWOCN

19.09.43 CWCN

19.09.44 CWON

19.09.45 CCCN

19.09.46 COCN

19.09.47 Certified Nurse-Midwives (CNMs)

19.10 Employment Specialty

19.10.01 Acute care/Critical Care - Nurses in this specialty provide care to

patients with acute conditions. They also provide care to pre- and post-

operative patients

19.10.02 Anesthesia - Nurses in this specialty provide care to patients receiving

anesthesia during operative procedures

19.10.03 Geriatric/Gerontology - Nurses in this specialty provide the special

care needed in rehabilitating and maintaining the mental and physical

health of the elderly

19.10.04 Home Health - Nurses in this specialty provide care for people in their

homes, such as those recovering from illness, an accident, or childbirth

19.10.05 Informatics48 - Nurses in this specialty integrate computer science,

information science, and nursing science and information to provide

support of patients, nurses, and providers to provide knowledge, data

integration, information processing, and technology communication.

19.10.06 Maternal-Child Health - Nurses in this specialty provide medical and

surgical treatment to pregnant women and to mother and baby

following delivery

56


19.10.07 Medical/Surgical - Nurses in this specialty provide diagnostic and

therapeutic services to acutely ill patients for a variety of medical

conditions, both surgical and non-surgical

19.10.08 Occupational Health - Nurses in this specialty provide on-the-job

health care for the nation's workforce, striving to ensure workers'

health, safety, and productivity

19.10.09 Oncology - Nurses in this specialty provide care and support for

patients diagnosed with cancer

19.10.10 Palliative Care - Nurses in this specialty provide sensitive care and

pain relief to patients in the final stages of life.

19.10.11 Pediatrics/Neonatal - Nurses in this specialty provide care and

treatment to young patients ranging in age from infancy to late teens;

provide care and support for very sick or premature newborn babies

19.10.12 Public Health - Nurses in this specialty provide population-based

community services

19.10.13 Psychiatric/Mental Health/Substance Abuse - Nurses in this specialty

aid and support the mental health of patients with acute or chronic

psychiatric needs; pain management nurses who help regulate

medications and provide care

19.10.14 Rehabilitation - Nurses in this specialty provide physical and emotional

support to patients and the families of patients with illnesses or

disabilities that affect their ability to function normally and that may

alter their lifestyle

19.10.15 School Health - Nurses in this specialty are dedicated to promoting the

health and well-being of children of all ages in an academic

environment

19.10.16 Trauma - Nurses in this specialty provide emergency care to patients of

all ages. These nurses work to maintain vital signs and prevent

complications and death

57


19.10.17 Women's Health - Nurses in this specialty provided care for women

across the life cycle with emphasis on conditions that are particular to

women

19.11 NPI (National Provider ID @ unit level)49 - This number will provide a unique

national provider number to every Medicare health care provider

19.11.01 Yes

19.11.02 No

LOINC Coding


76354-0 Licensed nurse demographics per unit or service

panel Panel 19

76355-7 Employment position panel [NMMDS] Panel 19.01

76356-5 Nurse employment position Provider

[NMMDS] LL3212-9

76353-2 Licensed nursing personnel #

76357-3 Licensed nursing personnel.employment

position [NMMDS] #

76358-1

Licensed nursing personnel.employment

position/ Licensed nursing personnel.nursing

unit %

76359-9 Licensed nursing personnel and sex panel

[NMMDS] Panel 19.02

76661-8 Sex of Provider [NMMDS] LL3275-6

76353-2 Licensed nursing personnel [NMMDS] #

76360-7 Licensed nursing personnel.sex[NMMDS] #

76361-5 Licensed nursing personnel.sex/ Licensed

nursing personnel.nursing unit [NMMDS] %

76362-3 Race or ethnicity panel [NMMDS] Panel 19.03

76663-4 Race or ethnicity of Provider [NMMDS] LL3276-4

76353-2 Licensed nursing personnel # [NMMDS] #

76363-1 Licensed nursing personel.race or ethnicity #

[NMMDS] #

76364-9

Licensed nursing personel.race or ethnicity/

Licensed nursing personnel.nursing unit

[NMMDS] %

76365-6 Age category panel [NMMDS] Panel 19.04

76366-4 Nurse age range Provider [NMMDS] LL3213-7


76367-2 Licensed nursing personnel.age range # #

58


[NMMDS]

76368-0 Licensed nursing personnel.age range/ Licensed

nursing personnel.nursing unit [NMMD] %

76369-8 Entry level nursing degree panel [NMMDS] Panel 19.05

76370-6 Entry level nursing degree Provider [NMMDS] LL3215-2


76371-4 Licensed nursing personnel.entry level nursing

degree # [NMMDS] #

76372-2 Licensed nursing personnel.entry level nursing

degree/ Licensed nursing personnel.n %

76373-0 Highest level of education in a nursing degree

panel [NMMDS] Panel 19.06

76374-8 Highest level of education in a nursing degree

Provider [NMMDS] LL3215-2

76353-2 Licensed nursing personnel # [NMMDS] {#} #

76375-5 Licensed nursing personnel.highest level of

education in a nursing degree # [NMMDS] #


education in a nursing degree/ Licensed %

76377-1 Highest level of education in non-nursing

degree panel [NMMDS] Panel 19.07

76378-9 Highest level of education in a non-nursing

degree Provider [NMMDS] LL3216-0



education in a non-nursing degree # [NMMDS] #

76380-5

Licensed nursing personnel.highest level of

education in a non-nursing degree/

Licensed.nursing unit [NMMDS] %

76381-3 Nursing license type panel [NMMDS] Panel 19.08

76382-1 Primary nursing license type Provider

[NMMDS] LL3214-5


76383-9 Licensed nursing personnel.primary nursing

license type # [NMMDS] #

76384-7

Licensed nursing personnel.primary nursing

license type/Licensed nursing personnel.nursing

unit %

76385-4 Nursing certification panel [NMMDS] Panel 19.09

76386-2 Nursing certification Provider [NMMDS] LL3218-6

76353-2 Licensed nursing personnel # [NMMDS] {#} #

76387-0 Licensed nursing personnel.nursing certification

# [NMMDS] #

59


76388-8

Licensed nursing personnel.nursing

certification/ Licensed nursing

personnel.nursing unit [NMMDS] %

76389-6 Employment specialty panel [NMMDS] Panel 19.10

76390-4 Nurse employment specialty Provider

[NMMDS] LL3219-4


76391-2 Licensed nursing personnel.employment

specialty # [NMMDS] #

76392-0 Licensed nursing personnel [NMMDS] %

76393-8 National provider indentifier panel [NMMDS] Panel 19.11

76398-7 Provider has a national provider ID LL361-7

76394-6 Registered nurse personnel # [NMMDS] #

76395-3 Registered nurse personnel.national provider ID

# [NMMDS] #

76396-1

Registered nurse personnel.national provider

ID/ Registered nurse personnel.nursing unit

[NMMDS] %

20 Clinical Mental work

The level of knowledge and decision-making required to perform role appropriate and

acceptable work on a nursing unit/service by type of nurse provider; and the Mental Workload

associated with the clinical work50.

Type of Nursing Provider - A designation for nursing personnel based on educational

preparation, licensure, or certification51-54.

1. APN

2. Registered Nurse, not APN

3. Licensed Practical/ Vocational Nurse (LPN/ LVN)

4. Unlicensed Assistive Personnel (UAP) i.e. nursing assistant or home health aide.

5. Total nursing personnel

20.01 Knowledge Required - The level of knowledge required by nursing personnel to

perform work on the unit or service. Estimate the % distribution of Knowledge

required for the Unit/Service by nursing personnel

60


20.01.01 Knowledge required Level 1 - Knowledge of simple routine or repetitive

tasks or operations that require little or no previous training or

experience

20.01.01.01 Knowledge required Level 1-1 - Knowledge of basic or

commonly used rules, procedures, or operations that requires

some previous training or experience

20.01.02.02 Knowledge required Level 2-2 - Knowledge of basic or

commonly used nursing procedures which are reflected in

licensure followed by training as a practical nurse or

vocational nurse

20.01.03.01 Knowledge required Level 3-1 - Knowledge of a body of

standardized rules, procedures, or operations that require

considerable training and experience to perform the full

range of standard nursing assignments and resolve recurring

problems.

20.01.03.02 Knowledge required Level 3-2 - Knowledge reflected in

licensure followed by training as a practical or vocational

nurse and sufficient work experience to demonstrate skill

sufficient to perform moderately difficult range of practical

nursing care.

20.01.04.01 Knowledge required Level 4-1- Knowledge of a wide variety

of interrelated or nonstandard assignments reflected in

licensure as a practical or vocational nurse and a broad work

experience that demonstrated skill sufficient to resolve a

range of problems with responsibility for carrying

assignments to completion.

20.01.04.02 Knowledge required Level 4-2 - A knowledge of nursing

comparable to that acquired through completion of a two

year college level program in nursing.

61


20.01.05 Knowledge required Level 5 - A basic knowledge of professional

nursing concepts, principles and practices comparable to that acquired

in the 3 year diploma or 4 year baccalaureate program.

20.01.06 Knowledge required Level 6 - Professional knowledge of established

concepts, principles and practices to perform professional nursing

assignments of moderate difficulty requiring training equivalent to an

educational program leading to a bachelor's degree and additional

training or experience.

20.01.07 Knowledge required Level 7 - Professional knowledge of a wide range

of nursing concepts, principles, and practices to perform highly

specialized nursing assignments of advanced nature and considerable

difficulty requiring extended specialized training and experience.

20.01.08 Knowledge required Level 8 - Mastery of nursing to apply

experimental theories and new developments to the solution of

complex health care problems not susceptible to treatment by accepted

methods; or to make decisions or recommendations significantly

changing, or developing, important public policies or programs; or

equivalent knowledge.

20.01.09 Knowledge required Level 9 - Mastery of the profession of nursing to

generate new hypotheses and develop new theories; or equivalent

knowledge.

20.02 Decision-Making Required - The nature and extent of choice identifying/selecting

that a worker must conduct to do acceptable work. Estimate the percentage of

nursing personnel working on the unit or service by decision-making level.

20.02.01 Decision-making required level 1 - Decisions require little or no choice

as: work consists of a few, simple, clear-cut, directly related and

quickly learned actions.

20.02.02 Decision-making required level 2 - Decisions that involve various

choices that require the employee to recognize the existence of and

differences among a few easily recognizable situations.

62


20.02.03 Decision-making required level 3 - Decisions that depend upon the

analysis of the subject phase, or issues involved in each assignment,

and the chosen course of action may have to be selected from many

alternatives.

20.02.04 Decision-making required level 4 - Decisions regarding what needs to

be done include the assessment of unusual circumstances, variations in

approach, and incomplete and conflicting data.


be done include major areas of uncertain issues and elements as the

work requires originating new techniques, establishing criteria, or

developing new information.


be done include largely undefined issues and elements and require

extensive probing and analysis to determine the nature and the scope of

the problems as the work requires continuing efforts to establish

concepts, theories, or programs, or to resolve unyielding problems.

20.03 Mental Work load - Time Load, Mental Effort Load and Psychological Stress Load

experienced by nursing personnel while working on a unit/service. Estimate the

percent distribution of Time Load, Mental Effort Load and Psychological Stress

Load experience by nursing personnel on the unit/service.50

20.03.01 Time Load - The total amount of time available to nursing personnel on a

unit/service to accomplish a task as well as overlap of tasks or parts of

tasks.

20.03.01.01 Time load level 1 - Often have spare time. Interruptions or

overlap among activities occur infrequently or not at all.

20.03.01.02 Time load level 2 - Occasionally have spare time.

Interruptions or overlap among activities occur frequently.

20.03.01.03 Time load level 3 - Almost never have spare time.

Interruptions or overlap among activities are frequent or

occur all the time.

63


20.03.02 Mental Effort - The amount of attention or concentration that is

required to perform a task

20.03.02.01 Mental effort load level 1 - Very little conscious mental

effort or concentration required. Activity is almost

automatic, requiring little or no attention.

20.03.02.02 Mental effort load level 2 - Moderate conscious mental effort

or concentration required. Complexity of activity is

moderately high due to uncertainty, unpredictability, or

unfamiliarity. Considerable attention required

20.03.02.03 Mental effort load level 3 - Extensive mental effort and

concentration are necessary. Very complex activity

requiring total attention.

20.03.03 Psychological Stress Load - The presence of confusion, frustration,

and/or anxiety associated with task performance

20.03.03.01 Psychological stress load level 1 - Little confusion, risk,

frustration, or anxiety exists and can be easily

accommodated.

20.03.03.02 Psychological stress load level 2 - Moderate stress due to

confusion, frustration, or anxiety noticeably adds to

workload. Significant compensation is required to maintain

adequate performance.

20.03.03.03 Psychological stress load level 3 - High to very intense

stress due to confusion, frustration, or anxiety. High to

extreme determination and self-control required.

LOINC Coding


77221-0 Clinical knowledge, decision making, and

mental workload panel [NMMDS]

20

57120-8 Type of nursing provider [NMMDS]

77222-8 Knowledge required level [NMMDS] 20.01

77223-6 Nursing staff.knowledge required level/


%





64


77224-4 Decision making required level [NMMDS] 20.02

77225-1 Nursing staff.decision making required

level/Nursing staff [NMMDS]

%

77226-9 Workload dimensions panel [NMMDS] 20.03

77227-7 Time load level [NMMDS] 20.03.01

77228-5 Nursing staff.time load level/Nursing staff

[NMMDS]

%

77229-3 Mental effort load level [NMMDS] 20.03.02

77230-1 Nursing staff.mental effort load level/


%

77231-9 Psychological stress load level [NMMDS] 20.03.03

77232-7 Nursing staff.psychological stress load level/


%

LOINC Answer List

57120-8 Type of nursing provider [NMMDS] – Normative List LL767-5


1 APN LA12063-6 01

2 RN LA6367-2 02

3 LPN/ LVN LA12071-9 03

4 UAP LA12085-9 04

5 Total nursing personnel LA12083-4 05

77222-8 Knowledge required level [NMMDS] – Normative list LL3587-4


1 Knowledge required Level 1 LA23736-4 20.01.01

2 Knowledge required Level 2-1 LA23737-2 20.01.02











77224-4 Decision making required level [NMMDS] – Normative list LL3586-6












65


1 Decision-making required level 1 LA23748-9 20.02.01






77227-7 Time load level [NMMDS] – Normative list LL3585-8


1 Time load level 1 LA23754-7 20.03.01.01



77229-3 Mental effort load level [NMMDS] – Normative list LL3588-2


1 Mental effort load level 1 LA23757-0 20.03.02.01



77231-9 Psychological stress load level [NMMDS] – Normative list LL3584-1


1 Psychological stress load level 1 LA23760-4 20.03.03.01



21 Environmental Conditions

Environmental condition is an external condition of having many diverse interrelated and

interdependent components linked through many interconnections. Environmental factors

include cultural, psychosocial, and physical factors which impact the immediate work

environment. To address environmental conditions, a survey should be created for nursing staff

on the unit to rate the perceived amount of cultural, psychosocial, and physical factors within

the nursing delivery unit/service55-57.

21.01.01 Cultural Factors - Cultural factors are factors that create an atmosphere

that is non-collegial and non-professional. Examples are decreased

loyalty to the institution by coworkers, decreased unit cohesiveness,

66


lack of trust and respect, the presence of time clocks, and the lack of

perquisites equal to physicians, such as a “nurses’ lounge.”

21.01.02 Cultural Factors Frequency

21.02.01 Psychosocial Factors - Episodes in which nurses have experienced

verbal assaults, physical violence, and/or feelings of conflict or friction

with coworkers, particularly physicians.

21.02.02 Psychosocial Factors Frequency

21.03.01 Physical Factors - Actual physical surroundings in which nurses work.

Examples are the multiple stimuli that affect concentration, or the lack

of any space that is quiet, or the lack of room to do the work—small

tight spaces with many people.

21.03.02 Physical Factors Frequency

LOINC Coding


75330-1 NMMDS environmental condition panel

75331-9 Total number of staff completing the

environmental conditions survey [NMMDS]

#

75332-7 To what extent do you agree or disagree with

cultural factors contributing to the phenomenon

of complexity?

LL2995-0 21.01.01

75333-5 Within the last month, how often have you

experienced cultural factors?

LL2996-8 21.01.02


psychosocial factors contributing to the

phenomenon of complexity?

LL2995-0 21.02.01


experienced psychosocial factors?

LL2712-9 21.02.02


physical factors contributing to the phenomenon

of complexity?

LL2995-0 21.03.01


experienced physical factors?

LL2712-9 21.03.02

LOINC Answer List

Normative answer list LL2995-0, LL2712-9










67


1 Strongly disagree LA15236-5 1

2 Disagree LA15773-7 2

3 Somewhat disagree LA15234-0 3

4 Somewhat agree LA15235-7 4

5 Agree LA15774-5 5

6 Strongly agree LA15237-3 6

Normative answer list LL2996-8


1 Rarely/Never LA21376-1 1

2 Sometimes LA10082-8 2

3 Often LA10044-8 3

4 Almost always/Always LA21377-9 4

22 Electronic Health Record (EHR) Implementation Stages

Stage representing the highest level of implementation of an EHR for the nursing unit or

service58. The information to answer this question would be collected by talking with the health

IT staff in the organization. The NMMDS is unit or service line information. It may be that a

single solution applied to an entire facility or it may be that the answer varies by unit or service

line. Complete the information for a unit or service line by selecting the highest stage of EHR

implementation.

22.01 Stage 0 - All three ancillaries not installed (laboratory, pharmacy, and radiology)

22.02 Stage 1 - Ancillaries - Lab, Rad, and Pharmacy - all installed

22.03 Stage 2 - Clinical Data Repository (CDR), Controlled Medical Vocabulary,

Clinical Decision Support (CDS), may have Document Imaging; Health

Information Exchange (HIE) capable

22.04 Stage 3 - Nursing/clinical documentation (flow sheets), CDSS (error checking),

Picture Archive and Communication Systems (PACS) available outside

Radiology

22.05 Stage 4 - Computerized Practitioner Order Entry (CPOE), Clinical Decision

Support (clinical protocols)

22.06 Stage 5 - The closed loop medication administration with bar coded unit dose

medications environment is fully implemented

68


22.07 Stage 6 - Physician documentation (structured templates), full CDSS (variance &

compliance), full Radiology-PACS

22.08 Stage 7 - Complete EMR; CCD transactions to share data; Data warehousing;

Data continuity with ED, ambulatory, OP

LOINC Coding


75744-3 Electronic health record implementation stage

panel

Panel 22

75745-0 Electronic health record implementation stage

75745-0 Electronic Health Record (EHR) Implementation Stage [NMMDS] -

LOINC Answer List

Normative answer list LL3104-8

Sequence # NMMDS Component Answer ID NMMDS code

1 Stage 0 - All three ancillaries not installed

(laboratory, pharmacy, and radiology)

LA21931-

3

22.01

2 Stage 1 - Ancillaries - Lab, Rad, Pharmacy - all

installed

LA21932-

1

22.02

3 Stage 2 - Clinical Data Repository (CDR),

Controlled Medical Vocabulary, Clinical

Decision Support (CDS), may have Document

Imaging; Health Information Exchange (HIE)

capable

LA21933-

9

22.03

4 Stage 3 - Nursing/clinical documentation (flow

sheets), CDSS (error checking), Picture Archive

and Communication Systems (PACS) available

outside Radiology

LA21934-

7

22.04

5 Stage 4 - Computerized Practitioner Order Entry

(CPOE), Clinical Decision Support (clinical

protocols)

LA21935-

4

22.05

6 Stage 5 - The closed loop medication

administration with bar coded unit dose

medications environment is fully implemented

LA21936-

2

22.06

7 Stage 6 - Physician documentation (structured

templates), full CDSS (variance & compliance),

full Radiology-PACS

LA21937-

0

22.07

8 Stage 7 - Complete EMR; CCD transactions to

share data; Data warehousing; Data continuity

with ED, ambulatory, OP

LA21938-

8

22.08

69


70


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56. Krichbaum K, Diemert C, Jacox L, et al. Complexity compression: Nurses under fire. Nurs

Forum. 2007;42(2):86-94.

57. Krichbaum KE, Peden-McAlpine C, Diemert C, Koenig P, Mueller C, Savik K. Designing a

measure of complexity compression in registered nurses. West J Nurs Res. 2011;33(1):7-25.

58. HIMSS Analytics. Electronic medical record adoption model (EMRAM).

http://www.himssanalytics.org/emram/emram.aspx. Updated 2013.

75


APPENDIX A – The Nursing Management Minimum Data Set Survey

THE NURSING MANAGEMENT MINIMUM DATA SET SURVEY DHuber & CDelaney2005

FINANCIAL RESOURCES

These NMMDS data elements were not updated with the 2013 – 2014 updates.

15 Payer Type

15.1 Total Health System (if applicable)

Refer to “Volume of Nursing Delivery Unit/Service” (Item 03). Calculate the percentage of total

service effort by

each of the following payer types for each encounter type identified for the total health system.

Payer Type Hours Days Visits Procedures Consults Contacts Programs Classes Enrollees

Government

15.11

Medicare

15.1101

Medicaid

15.1102

Public Health Service

(PHS)

15.1103

PHS-Indian

76


15.1104

Military Health System

(TRICARE)

15.1105

Dept. of Justice

15.1106

State Employer

15.1107

State Health Service

15.1108

Non-government

15.12

Health Maintenance

Organization (HMO)

15.1201

Preferred Provider

Organization

(PPO)

15.1202

Discount Fee-for-

Service

15.1203

Commercial Insurance

15.1204

Workers’

Compensation

77


15.1205

Industrial

15.1206

Trust Accounts

15.1207

Self Pay

15.1208

Indigent

15.1209

Charity

15.1210

Multi-Method

15.13

Non-patient Revenue

Generation

15.14

78


15.2 Total Organization


service effort by

each of the following payer types for each encounter type identified for the total organization.


Government

15.21

Medicare

15.2101

Medicaid

15.2102


(PHS)

15.2103

PHS-Indian

15.2104


(TRICARE)

15.2105

Dept. of Justice

15.2106

State Employer

15.2107


15.2108

79


Non-government

15.22

Health Maintenance

Organization (HMO)

15.2201

Preferred Provider

Organization

(PPO)

15.2202

Discount Fee-for-

Service

15.2203


15.2204

Workers’

Compensation

15.2205

Industrial

15.2206

Trust Accounts

15.2207

Self Pay

15.2208

Indigent

15.2209

Charity

80


15.2210

Multi-Method

15.23

Non-patient Revenue

Generation

15.24

81


15.3 Total Nursing Department


service effort by

each of the following payer types for each encounter type identified for the total nursing

department.


Government

15.31

Medicare

15.3101

Medicaid

15.3102


(PHS)

15.3103

PHS-Indian

15.3104


(TRICARE)

15.3105

Dept. of Justice

15.3106

State Employer

15.317


82


15.3108

Non-government

15.32

Health Maintenance

Organization (HMO)

15.3201

Preferred Provider

Organization

(PPO)

15.3202

Discount Fee-for-

Service

15.3203


15.3204

Workers’

Compensation

15.3205

Industrial

15.3206

Trust Accounts

15.3207

Self Pay

15.3208

Indigent

15.3209

83


Charity

15.3210

Multi-Method

15.33

Non-patient Revenue

Generation

15.34

84


15.4 Nursing Delivery Unit/Service


service effort by

each of the following payer types for each encounter type identified for the nursing delivery

unit/service.


Government

15.41

Medicare

15.4101

Medicaid

15.4102


(PHS)

15.4103

PHS-Indian

15.4104


(TRICARE)

15.4105

Dept. of Justice

15.4106

State Employer

15.4107


85


15.4108

Non-government

15.42

Health Maintenance

Organization (HMO)

15.4201

Preferred Provider

Organization

(PPO)

15.4202

Discount Fee-for-

Service

15.4203


15.4204

Workers’

Compensation

15.4205

Industrial

15.4206

Trust Accounts

15.4207

Self Pay

15.4208

Indigent

15.4209

86


Charity

15.4210

Multi-Method

15.43

Non-patient Revenue

Generation

15.44

87


16 Reimbursement

16.1 Total Health System (if applicable)

Identify the percentage distribution of reimbursement received for the total

health system.

Payment Basis % Services Delivered % Revenue

Fee for service

16.11

Discounted fee for service

16.12

Per diem

16.13

Diagnosis Related Group (DRG)

16.14

All Payer Group (APG)

16.15

Per visit

16.16

Per member/month

16.17

16.2 Total Organization

Identify the percentage distribution of reimbursement received for the total organization.

88



Fee for service

16.21


16.22

Per diem

16.23


16.24


16.25

Per visit

16.26

Per member/month

16.27

89


16.3 Total Nursing Department

Identify the percentage distribution of reimbursement received for the total

nursing department.


Fee for service

16.31


16.32

Per diem

16.33


16.34


16.35

Per visit

16.36

Per member/month

16.37

16.4 Nursing Delivery Unit/Service

Identify the percentage distribution of reimbursement received for the nursing

delivery unit/service.

90



Fee for service

16.41


16.42

Per diem

16.43


16.44


16.45

Per visit

16.46

Per member/month

16.47

91


17 Nursing Delivery Unit/Service Budget

17.1 Costs

17.11 Organization - Health System (if applicable)

Identify the planned and actual organizational budget figures as a percentage

of the health system’s annual itemized budget.

Organization

Costs

System’s Planned

Budget

System’s Actual

Budget

Wages (hours)

17.111

Salaries per year

17.112

Benefits

17.113

Depreciation

17.114

Supplies

17.115

Other operating expenses

17.119

92


17.12 Nursing Department - Organization

Identify the planned and actual nursing department budget figures as a

percentage of the organization’s annual itemized budget.

Nursing Department

Costs

Organization’s

Planned

Budget

Organization’s

Actual Budget

Wages (hours)

17.121

Salaries per year

17.122

Benefits

17.123

Depreciation

17.124

Supplies

17.125

Other operating expenses

17.129

93


17.13 Nursing Delivery Unit/Service - Nursing Department

Identify the planned and actual nursing delivery unit/service budget figures as

a percentage of the nursing department’s annual itemized budget.

Nursing Delivery

Unit/Service Costs

Nursing Department’s

Planned Budget


Actual Budget

Wages

17.131

Salaries

17.132

Benefits

17.133

Depreciation

17.134

Supplies

17.135

Other operating

expenses

17.139

94


17.2 Revenues

17.21 Organization - Health System (if applicable)

Identify the planned and actual organizational revenue as a percentage of the health

system’s annual revenues.

Organization Revenue System’s

Planned Budget

System’s

Actual Budget

Revenue

17.211


Identify the planned and actual nursing department revenue as a percentage of the

organization’s annual revenues.

Nursing Department

Revenue

Organization’s

Planned Budget

Organization’s

Actual Budget

Revenue

17.221


Identify the planned and actual nursing delivery unit/service revenue as a percentage

95


of the nursing department’s annual revenues.

Nursing Delivery

Unit/Service Revenue


Planned Budget


Actual Budget

Revenue

17.231

96


18 Expenses

18.1 Organization – Health System (if applicable)

Identify the following expenses of the total organization as a percentage of the

health system’s total expenses for the reporting year.

Measures Percent of total

expenses

Direct:

Sum of labor costs directly attributable to a unit of service

including wages, benefits, travel, recruitment, education

per year.

18.11

Direct material:

Sum of material costs, including patient/client supplies

used to provide the unit of service per year.

18.12

Indirect:

Capital; equipment; an expense depreciated over time;

administration; labor expenses shared by more than

one nursing unit/service; clinical program development;

expenses for future development per year.

18.13


97


Identify the following expenses of the total nursing department as a percentage of the

organization’s total expenses for the reporting year.


expenses

Direct:



per year.

18.21

Direct material:



18.22

Indirect:


administration; labor expenses shared by more than one

nursing unit/service; clinical program development;


18.23

98



Identify the following expenses of the nursing delivery unit/service as a percentage

of the nursing department’s total expenses for the reporting year.


expenses

Direct:



per year.

18.31

Direct material:



18.32

Indirect:


administration; labor expenses shared by more than one

nursing unit/service; clinical program development;


18.33

99


APPENDIX B - Publications - NMMDS Articles Published

Delaney CW, Huber D, (eds.). A Nursing Management Minimum. Data Set (NMMDS): A

Report of an Invitational Conference. Chicago, IL: The American Organization of Nurse,

1996.

Delaney C, Reed D, and Clarke, M. (2000). Describing patient problems & nursing treatment

patterns using nursing minimum data sets (NMDS & NMMDS) & UHDDS repositories.

Proceedings of AMIA - Annual Symposium. AMIA Symposium 2000; pp. 176-9.

Delaney C. Significance of the nursing minimum dataset for decision support in acute care. In:

Mills MEC, Romano CA, Heller BR, editors. Information management in nursing and

health care. Springhouse, PA: Springhouse; 1996; pp. 32-8.

Huber D, and Delaney CW. The Nursing Management Minimum Data Set (NMMDS): Data

Elements. Unpublished manuscript, 2005.

Huber D, Schumacher L, and Delaney C. Nursing Management Minimum Data Set (NMMDS).

Journal of Nursing Administration 1997: 27(4): 42-8.

Huber D, Delaney C. The American Organization of Nurse Executives (AONE) research

column. The Nursing Management Minimum Data Set. Appl Nurs Res 1997: 10(3): 164-5.

Jones J, Newsom ET, and Delaney C. Use of nursing management minimum data set (nmmds)

for a focused information retrieval. San Diego: CA ed., 2009.

Kunkel DE, Westra BL, Hart CM, Subramanian A, Kenny S, and Delaney CW. Updating and

normalization of the nursing management minimum data set element 6: Patient/client

accessibility. CIN - Computers Informatics Nursing 2012: 30(3), 134-41.

Subramanian A, Westra BL, Matney SA, Wilson PS, Delaney C, Huff SM, and Huber DL.

Integrating the nursing management minimum data set into the Logical Observation

Identifier Names and Codes system. Proceedings of AMIA - Annual Symposium. AMIA

Symposium 2008; pp. 1148.

Westra B, Subramanian A, Hart C, Matney S, Wilson P, Huff S, et al. Achieving "Meaningful

Use" of Electronic Health Records Through the Integration of the Nursing Management

Minimum Data Set. Journal of Nursing Administration 2010: 40(7/8): 336-43.