I-NSC-2-Option-1-Full-Version
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Joint Commission International (I) Library of Measures Version 2.0
Nursing Sensitive Care (I-NSC-2)
Pressure Ulcer Event
Data Collection Tool for All Eligible Inpatient Units
(Pressure Ulcer Collection Tool: Option 1)
Underlined Blue Text = each question’s data element name which links to the data dictionary notes for abstraction;
the data elements are used as decision points in the algorithm. The blue text appendices found in the ( ) = links to the
medication and ICD code appendix tables.
Use Ctrl + Home keys to go to the title page
©2011 Joint Commission International
This form is not part of the medical record and is intended for quality improvement purposes
only. 1
Medical Record Abstractor: Abstract data for your organization’s selected measures
with the measure code name I-NSC-2 designated in the left hand column under each
data element question. This form is to be used to collect inpatient data for each patient
on the selected unit at the time of the study during the Quarterly Prevalence
Study Day.
Requires a 2-step-process: 1st patient physical observation and 2nd medical record
chart review
Hospital Name: _______________________________________________________________________________________________________________________________
+Plus symbol indicates required administrative data field
+Hospital Patient Number/Identifier
+Admission Date
/ /
dd mm yyyy Sex +Name of Unit
After the case data abstraction and data flow is completed, circle the assigned Measure Category
Assignment (MCA) Letter for each measure as guided by the allowable answer value “STOP” text:
EXAMPLE: If answered 0 or unable to determine, STOP I-NSC-2 data abstraction = case is IN the
Measure Population =D
If there is no text prompt instructing you to STOP, continue data collection.
1. What is the date the patient was admitted to
acute inpatient care?: Admission Date
(I-NSC-2)
/ / Unable to determine
(UTD)
Day (01 – 31)
Month (01 – 12)
YYYY (2010 – current year)
If answered UTD, STOP data abstraction for I-NSC-2 =
case NOT in Initial Population
2. Patient’s Birthdate: (dd/mm/yyyy): Birthdate
Age= admission date – birthdate
(I-NSC-2)
_______ / _________ /____________ Not Available
dd mm yyyy
Age: year/s (admission date – birthdate) Joint Commission International (I) Library of Measures Version 2.0
Nursing Sensitive Care (I-NSC-2)
Pressure Ulcer Event
Data Collection Tool for All Eligible Inpatient Units
(Pressure Ulcer Collection Tool: Option 1)
Underlined Blue Text = each question’s data element name which links to the data dictionary notes for abstraction;
the data elements are used as decision points in the algorithm. The blue text appendices found in the ( ) = links to the
medication and ICD code appendix tables.
Use Ctrl + Home keys to go to the title page
©2011 Joint Commission International
This form is not part of the medical record and is intended for quality improvement purposes
only. 2
If age < 18 year old, STOP data abstraction for I-NSC-2 =
case NOT in Initial Population
3. What is the type of unit/location?: Type of Unit
(I-NSC-2)
1. Critical Care –adult
2. Step-down – adult
3. Medical – adult
4. Surgical – adult
5. Med-Surg Combined – adult
6. Mixed acuity – adult
4. What was the date of the prevalence study conducted (skin
inspection)?: Prevalence Study Date
(I-NSC-2)
/ /
Day (01 – 31)
Month (01 – 12)
YYYY (2001 – current year)
5. How many pressure ulcers were observed on this patient the
day of the prevalence study?: Observed Pressure Ulcer(s)
(I-NSC-2)
1st step: physical observation
___________ or UTD(unable to determine)
(0-48)
If answered 0 or unable to determine, STOP I-NSC-2 data
abstraction = case is IN the Measure Population =D
6. What was the category/stage for this pressure ulcer?:
Observed Pressure Ulcer – Category/stage
Note: This data element needs to be completed for each
observed pressure ulcer. Refer to worksheet table below.
(I-NSC-2)
1st step: physical observation 1- Category/stage I - Non-blanchable erythema
2 -Category/stage II– Partial thickness
3 -Category/stage III– Full thickness skin loss
4- Category/stage IV– Full thickness tissue loss
5- Unstageable/ Unclassified– Full thickness skin or
tissue loss – depth unknown
6- Suspected deep tissue injury– depth unknown
7 -There is no documentation of category/stage or Unable
to Determine from the documentation
If answered 1 , for ALL pressure ulcers, STOP I-NSC-2
