A pressure ulcer and fall rate quality composite index for acute care units: A measure development study.
Diane K Boyle, Ananda Jayawardhana, Mary E Burman and 4 others
PMID 27607602WHAT IT FOUND
The unit-level composite score starts at 100 and subtracts one point for each percent of patients with hospital-acquired pressure ulcers and one point for each fall per 1000 patient days.
Higher scores mean fewer pressure ulcers and falls combined.
Key findings
01The unit-level composite index starts at 100 and subtracts one point for each percent hospital-acquired pressure ulcer rate and one point for each fall per 1000 patient days.
02In 5,144 units, higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate degree or higher, higher percent with national specialty certification, and lower percent of nursing hours supplied by agency nurses were associated with higher composite scores; lower total nursing hours was also associated with higher scores.
03Lower mean pressure ulcer prevention measures in place was associated with higher composite scores, while risk assessment in the last 24 hours and restraint use were not significant.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The hospitals and units were from an elective nursing quality database, so they are not representative of all U.S. hospitals and under-represent small hospitals. Only 5,144 units with complete data were included, and units had to report both pressure ulcer and fall rates, so other units were excluded. The pressure ulcer risk variable was removed because it had a 0.90 correlation with mean prevention measures, so the study could not directly test whether higher risk lowered the composite score. Lower total nursing hours per patient day was associated with higher composite scores, opposite the expected direction, so total hours may mix registered nurse, licensed practical/vocational nurse and nurse aide hours. Smaller units should be cautious applying the index over short periods; the sensitivity analysis excluded units with fewer than 30 patients assessed for pressure ulcers. The analysis was at unit level, not patient level, so it does not show how an individual patient's care changed.
The easy way to misread this
Do not read the finding that lower total nursing hours per patient day was associated with a higher composite score as evidence that fewer nursing hours improve care. Total hours combine registered nurse, licensed practical/vocational nurse and nurse aide hours, and the study shows association, not causation.