Modeling Hospital‐Acquired Pressure Ulcer Prevalence on Medical‐Surgical Units: Nurse Workload, Expertise, and Clinical Processes of Care. (7th October 2014)

• Record Type: Journal Article
• Authors: Aydin, Carolyn; Donaldson, Nancy; Stotts, Nancy A.; Fridman, Moshe; Brown, Diane Storer
• Is Part Of: Health services research. Volume 50:Number 2(2015)
• Page Start: 351
• Page End: 373
• Publication Date: 2014-10-07
• Subjects: Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12244
• Languages: English
• ISSNs: 0017-9124

Abstract

<abstract abstract-type="main" id="hesr12244-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hesr12244-sec-0001" sec-type="section"> <title>Objective</title> <p>This study modeled the predictive power of unit/patient characteristics, nurse workload, nurse expertise, and hospital‐acquired pressure ulcer (HAPU) preventive clinical processes of care on unit‐level prevalence of HAPUs.</p> </sec> <sec id="hesr12244-sec-0002" sec-type="section"> <title>Data Sources</title> <p>Seven hundred and eighty‐nine medical‐surgical units (215 hospitals) in 2009.</p> </sec> <sec id="hesr12244-sec-0003" sec-type="section"> <title>Study Design</title> <p>Using unit‐level data, HAPUs were modeled with Poisson regression with zero‐inflation (due to low prevalence of HAPUs) with significant covariates as predictors.</p> </sec> <sec id="hesr12244-sec-0004" sec-type="section"> <title>Data Collection/Extraction Methods</title> <p>Hospitals submitted data on NQF endorsed ongoing performance measures to CALNOC registry.</p> </sec> <sec id="hesr12244-sec-0005" sec-type="section"> <title>Principal Findings</title> <p>Fewer HAPUs were predicted by a combination of unit/patient characteristics (shorter length of stay, fewer patients at‐risk, fewer male patients), RN workload (more hours of care, greater patient [bed] turnover), RN expertise (more years of experience, fewer contract staff hours), and processes of care (more risk assessment completed).</p> </sec> <sec id="hesr12244-sec-0006" sec-type="section"> <title>Conclusions</title> <p>Unit/patient characteristics were potent HAPU predictors yet generally are not modifiable. RN workload, nurse expertise, and processes of care (risk assessment/interventions) are significant predictors that can be addressed to reduce HAPU. Support strategies may be needed for units where experienced full‐time nurses are not available for HAPU prevention. Further research is warranted to test these finding in the context of higher HAPU prevalence.</p> </sec> </abstract>