Modeling hospital-acquired pressure ulcer prevalence on medical-surgical units: nurse workload, expertise, and clinical processes of care

Abstract

Objective: 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.

Data sources: Seven hundred and eighty-nine medical-surgical units (215 hospitals) in 2009.

Study design: Using unit-level data, HAPUs were modeled with Poisson regression with zero-inflation (due to low prevalence of HAPUs) with significant covariates as predictors.

Data collection/extraction methods: Hospitals submitted data on NQF endorsed ongoing performance measures to CALNOC registry.

Principal findings: 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).

Conclusions: 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.

Keywords: Nursing; acute inpatient care; modeling; quality of care/patient safety (measurement).

Figure 1

Overview of Significant Model Findings

Figure 2

Predicted HAPU Any Stage and HAPU II+ by Key Model Predictors Notes Mean licensed hours per patient day = 7.53. Mean HAPU-any stage = 2.3. Mean HAPU II+ = 1.4. Solid curve indicates sample unit average (group mean). Continuous and categorical model predictors not depicted were set to the overall sample averages or proportions, respectively.

Figure 3

Predicted HAPU Any Stage and HAPU II+ by Key Model Predictors Notes. Mean total hours per patient day = 9.85; mean patient (bed) turnover as percent of total patient days = 57.6. Mean HAPU-any stage = 2.3. Mean HAPU II+ = 1.4. Solid curve indicates sample unit average levels (group mean). Continuous and categorical model predictors not depicted were set to the overall sample averages or proportions, respectively.