The development of Nursing Quality Care Process Metrics and Indicators for use in Older Persons Care Settings: A Delphi-Consensus Study.

AIM: To develop a suite of nursing quality care process metrics and indicators for older persons care settings in Ireland. BACKGROUND: Regulatory investigations of health system failures highlight non-adherence to clinical guidelines and standards resulting in deficiencies in nursing care delivery. Limited attention has been paid to measuring nursing care processes particularly in the care of older people. Quality care process metrics can facilitate measurement of nurse-sensitive measures of care. DESIGN: A scoping literature review and modified Delphi-Consensus Technique. METHODS: A scoping review of literature published between January 2007 - January 2017 was conducted to identify nursing process metrics and indicators. The Delphi Consensus phase incorporated a four-round electronic survey of 404 nurses and a consensus meeting with 13 stakeholders working in Older Persons Care Settings in Ireland. FINDINGS: From the review, 33 potential metrics were identified. After all Delphi survey rounds, 20 metrics and 90 associated indicators were selected by the nurses. Following the consensus meeting, 19 metrics and 80 indicators were included in the final suite of nursing quality care process metrics and indicators. CONCLUSION: Developing this suite of nursing quality care process metrics and indicators for use in older persons care settings provided consensus on what nursing processes should be measured to improve the quality and safety of care delivery. IMPACT: The nursing processes identified, provide a framework for future research and educational programmes in the care of older persons. Although conducted in the Irish healthcare system, there is potential for adoption or adaption in other healthcare settings.