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 HAPU s. Data Sources: Seven hundred and eighty‐nine medical‐surgical units (215 hospitals) in 2009. Study Design: Using unit‐level data, HAPU s were modeled with Poisson regression with zero‐inflation (due to low prevalence of HAPU s) with significant covariates as predictors. Data Collection/Extraction Methods: Hospitals submitted data on NQF endorsed ongoing performance measures to CALNOC registry. Principal Findings: Fewer HAPU s 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.