Salem Health instrumental in developing new ambulatory nursing quality metrics

Salem Health Hospitals & Clinics is one of a group of leading hospitals and health systems that have joined with Collaborative Alliance for Nursing Outcomes to monitor and benchmark ambulatory nursing performance.

These organizations were instrumental in helping develop the nation’s first nursing quality indicators database, designed to increase the quality of patient care.

“We are participating with this effort to help the national community understand best practices,” says Barb Merrifield, director of Magnet® program and nursing clinical excellence, Salem Health.

What is this new database?

The CALNOC database was developed to measure and improve nurse-sensitive indicators across all hospitals in the country. In 2013, the American Academy of Ambulatory Care Nursing's board of directors commissioned a task force to identify and define NSIs specific to the ambulatory care setting. CALNOC was part of this task force — which included representatives from all geographic areas and a broad range of specialties and locations. As a result of this work, CALNOC and its collaborators are developing a specific set of ambulatory NSIs.

What are nurse-sensitive indicators?

Nurse-sensitive indicators are the points at which nurse practices have the greatest impact on patient safety and care. NSIs show stakeholders the value of nursing by presenting the direct effects of nursing on patient care and patient outcomes. These metrics include metrics such as incidents of harmful falls and surgical center patient burns.

What is ambulatory care?

Ambulatory care includes any same-day treatment that happens in an outpatient setting – where the patient doesn’t need to be admitted to a hospital for treatment. This includes care at hospital-based clinics, medical practices, emergency departments, ambulatory surgery and diagnostic procedure centers, telehealth service environments, university and community hospital clinics, military and veterans’ administration settings, nurse-managed clinics, managed care organizations, colleges and educational institutions, freestanding community facilities, coordinated care organizations and patient homes.

How did Salem Health participate?

Nursing leaders from Salem Health participated in the technical advisory panel on pain assessment and follow-up. When AAACN called for experts, nursing leaders from Salem Health participated in the technical advisory panel on pain assessment and follow-up in order to develop NSIs specific to the ambulatory care setting. These NSIs include:

  • Readmissions
  • Pain assessment and follow-up
  • Nurse screening for high blood pressure
  • Nurse screening and follow-up for depression
  • Patient falls and screening for future falls risk
  • Screening for body mass index
  • Care coordination measures:  Appropriate referral, reduction of readmission, population health management through advanced care planning, decreasing pediatric ED visits; patient engagement-patient activation
  • Administration of vaccine
  • Clean urine specimen
  • Wound care center healing rates
  • Opioid monitoring and safety at pain centers
  • Reduction of readmissions via follow-up phone calls
  • Management of pediatric overweight and obesity

“Advancing the quality of nursing care in ambulatory settings is a national priority,” says Margo Halm, former director of research, professional practice and Magnet, Salem Health. “Salem Health is dedicated to quality in nursing and participating in these panels highlights that commitment.”

Salem Health will continue to work with CALNOC to benchmark and measure NSIs as they become available to the nursing community. This work is part of Salem Health’s broader commitment to nursing quality through the Magnet Recognition Program®. For more information about Salem Health’s nursing excellence, please visit

About Salem Health Hospitals & Clinics: Salem Health offers exceptional care to people in and around Oregon’s Mid-Willamette Valley. It comprises hospitals in Salem and Dallas, a medical group of primary and specialty care providers, plus other affiliated services. Visit us at; “Like” us on; follow us on Twitter: @salemhealth; and view us at