International Journal of Clinical Case Reports, 2026, Vol.16, No.1, 66-83 http://medscipublisher.com/index.php/ijccr 72 Table 1 Core nursing-sensitive indicators (NSIs) for hospitalized older adults Domain Core NSI Indicator Indicator Description Modifiable Nursing Targets Data Source Recommended Metric Structure Geriatric-trained nurse staffing ratio Proportion of nurses with geriatric care qualifications Nurse staffing and competency management Human resources system Percentage (%) Nursing staff training coverage Completion of geriatric and safety-related training Continuing education and skill development Training management records Compliance rate (%) Availability of fall- and pressure-injury-prevention equipment Adequacy and accessibility of protective equipment Equipment allocation and maintenance Nursing management records Availability rate (%) Process Fall risk assessment compliance Completion of standardized fall risk assessments Risk screening and ongoing reassessment Electronic medical records Compliance rate (%) Pressure injury risk assessment compliance Use of tools such as the Braden scale Early identification of high-risk patients Electronic medical records (EMR) Compliance rate (%) Appropriate restraint use compliance Adherence to indications and protocols for restraints Alternatives to restraints and monitoring Nursing documentation Compliance rate (%) Medication administration safety compliance Double-checking and safe administration of high-risk medications Medication verification and patient education Electronic medical records (EMR) Compliance rate (%) Outcome In-hospital fall incidence rate Falls occurring during hospitalization Environmental safety and nursing surveillanc Adverse event reporting system Incidence per 1000 patient-days Hospital-acquired pressure injury incidence rate New pressure injuries developed during hospitalization Repositioning and skin care interventions Adverse event reporting system Incidence per 1 000 patient-days Nursing-related infection rate Infections associated with nursing procedures Aseptic technique and device care Infection control system Incidence per 1000 patient-days Overall nursing adverse event rate Falls, pressure injuries, medication errors, etc Comprehensive nursing quality improvement Adverse event reporting system Incidence per 1 000 patient-days Meanwhile, national indicator programs that monitor long-term trends and conduct inter-institutional benchmarking can identify quality improvement priorities and research gaps, offering macro-level evidence to support sustained improvement efforts. With advances in information technology, multidimensional data integration and visualization have become increasingly important tools in nursing quality management. Embedding NSIs into information systems and applying statistical process control (SPC) methods (e.g., control charts) for real-time or periodic monitoring facilitates early detection of abnormal variation, triggers root cause analysis, and supports evidence-based decision-making, thereby promoting a shift from “outcome reporting” to “process governance” in quality management (Figure 1). 4.2 Current status of nursing quality and adverse event occurrence in hospitalized older patients Existing research and quality monitoring evidence indicate that preventable nursing-sensitive adverse events remain common among hospitalized older adults, with substantial variation across wards and institutions, reflecting persistent gaps in nursing quality. In studies of geriatric trauma patients, approximately 30% experienced at least one nursing-sensitive adverse event, most commonly healthcare-associated infections (19%), bladder overdistension (11%), pressure injuries (6%), and malnutrition (5%). Patients who experienced events were older, frailer, more severely injured, and had nearly threefold longer hospital stays than those without events
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