title: Adverse patient occurrences as a measure of nursing care quality.
abstract: OBJECTIVE
  The purpose of this study was to describe relationships among adverse patient occurrences aggregated at the unit level of measurement. Relationships between adverse occurrences and a patient acuity measure were also described.
  
  
  BACKGROUND
  Adverse patient occurrence data have been traditionally a major indicator of quality care in hospitals; however, few studies have examined relationships among these indicators or the usefulness of these indicators for assessing the quality of nursing care.
  
  
  METHODS
  A correlational design was used to examine and describe patterns of relationships among in-patient units in a tertiary care hospital. The results demonstrated positive correlations between medication error rates and patient falls; these adverse occurrences correlated negatively with pressure ulcers, infections, patient complaints, and death. Pressure ulcers, infections, patient complaints and death intercorrelated positively and also related positively to patient acuity levels.
  
  
  RESULTS
  An examination of these same rates for a subset of units with similar patient acuity levels revealed that most of the interrelationships among the entire set of adverse occurrence indicators were positive. When patient acuity was taken into account, these adverse outcomes appeared to indicate some common underlying characteristic of the units, such as quality of nursing care.
  
  
  CONCLUSIONS
  This study suggests a relationship between the adverse occurrences that were correlated (pressure ulcers, patient complaints, infection, and death) and the severity of patient illness. Medication error rates and patient fall rates were not correlated with patient acuity and are more likely to indicate quality of nursing care across all types of units.
authors.affiliation: University of Iowa Hospitals and Clinics, USA.
authors.forename: L
authors.initials: L
authors.lastname: Reed
authors.forename: M A
authors.initials: MA
authors.lastname: Blegen
authors.forename: C S
authors.initials: CS
authors.lastname: Goode
mesh_terms: D000058:Accidental Falls; D003428:Cross Infection / Q000209:etiology; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D008508:Medication Errors; D009738:Nursing Service, Hospital / Q000592:standards*; D017060:Patient Satisfaction; D010361:Patients / Q000145:classification; D003668:Pressure Ulcer / Q000209:etiology; D019984:Quality Indicators, Health Care; D012308:Risk Management; D012720:Severity of Illness Index; D014481:United States