Hospital-Acquired Pressure Injury: Risk-Adjusted Comparisons in an Integrated Healthcare Delivery System.
June Rondinelli, Stephen Zuniga, Patricia Kipnis and 3 others
PMID 29240656WHAT IT FOUND
Older age, higher acute illness severity, and heavier comorbidity burden were linked to more pressure injury risk beyond Braden scores.
Hospital-to-hospital variation remained.
Key findings
01In the adjusted model, older age, higher COPS2, and higher LAPS2 increased pressure injury hazard, while higher Braden score, female sex, and medical emergency room admission lowered it.
02After adjustment, hospitals with effects above 1 standard deviation were reported to have more than 90% higher pressure injury risk.
03The cohort had 2.2 cases per 1,000 episodes; Stage 2 and deep tissue injury were the most common first injuries.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Retrospective hospital-record study, so it shows associations rather than proof that any assessment or prevention change causes fewer pressure injuries. Patients were cared for in a single integrated Kaiser Permanente system with low baseline pressure injury rates, so the model may need recalibration in other hospitals. The study could not measure the actual quality of nursing pressure injury prevention, such as how often turning, repositioning, surfaces, nutrition, or incontinence care was delivered. Only the lowest total Braden score in the first 24 hours was used, not subscale scores or later reassessments. Hospital-acquired pressure injury location and device-specific percentages were not available. COPS2 includes diabetes, which may explain why diabetes itself was not significant despite being a known pressure injury risk factor. Body mass index and individual contribution of chronic renal failure were not captured. The cause-specific model is better for understanding associations than for predicting an individual patient's risk.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the risk scores as proof that adding them to Braden assessment prevents pressure injuries. This was an observational study of hospital records, and the authors could not measure the quality of pressure injury prevention nursing care.