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Modeling Hospital-Acquired Pressure Ulcer Prevalence on Medical-Surgical Units: Nurse Workload, Expertise, and Clinical Processes of Care

Aydin, Carolyn, Donaldson, Nancy, Stotts, Nancy A., Fridman, Moshe and Brown, Diane (2015). Modeling Hospital-Acquired Pressure Ulcer Prevalence on Medical-Surgical Units: Nurse Workload, Expertise, and Clinical Processes of Care. BMC Health Services Research,50(2):351-373.

Document type: Journal Article
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Title Modeling Hospital-Acquired Pressure Ulcer Prevalence on Medical-Surgical Units: Nurse Workload, Expertise, and Clinical Processes of Care
Author Aydin, Carolyn
Donaldson, Nancy
Stotts, Nancy A.
Fridman, Moshe
Brown, Diane
Journal Name BMC Health Services Research
Publication Date 2015
Volume Number 50
Issue Number 2
ISSN 1472-6963   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84924594784
Start Page 351
End Page 373
Total Pages 23
Place of Publication United Kingdom
Publisher BMC Health Services Research
HERDC Category C1 - Journal Article (DIISR)
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
Quality of care/patient safety (measurement)
Acute inpatient care
Modeling
DOI http://dx.doi.org/10.1111/1475-6773.12244   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 4.0 License
URL https://creativecommons.org/licenses/by/4.0/au


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