title: Exploring variation in pressure ulcer prevalence in Sweden and the USA: benchmarking in action.
abstract: OBJECTIVE
  To compare overall unit-level pressure ulcer (PU) prevalence, hospital-acquired pressure ulcer (HAPU) prevalence and prevention strategies, as well as nurse staffing and workload in two hospitals in Sweden with data from the USA.
  
  
  METHODS
  Medical and surgical units in a university hospital and a general hospital in Sweden were compared with 207 hospitals in the USA participating in the Collaborative Alliance for Nursing Outcomes (CALNOC) benchmarking registry. All adult inpatients in university hospital (n = 630), general hospital (n = 253) and CALNOC hospitals (n = 3506) were included in the study. Outcome indicators were pressure ulcer prevalence for all types (PU) and HAPU prevalence, specifically. Process indicators were risk assessment and PU prevention strategies. Structure indicators were nurse staffing (hours of care, and skill mix) and workload (admissions, discharges and transfers).
  
  
  RESULTS
  The prevalence of PU (categories 1-4) was 17.6% (university hospital) and 9.5% (general hospital) compared with 6.3-6.7% in the CALNOC sample. The prevalence of full thickness HAPU (categories 3 and 4) was 2.7% (university hospital) and 2.0% (general hospital) compared with 0-0.5% in the CALNOC sample. Risk and skin assessment varied between 6% and 60% in the Swedish hospitals compared with 100% in the CALNOC sample. Total hours per patient day were 8.4 in both Swedish hospitals and 9.5 to 9.8 in the CALNOC hospitals
  
  
  CONCLUSIONS
  The findings suggest a link between processes of care and outcomes that is exciting to observe internationally and suggest the opportunity to expedite performance improvement through global benchmarking. Using HAPU as a complement to point prevalence of PU in Sweden has revealed this indicator as a more valid measure for patient care quality.
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden. lena.gunningberg@pubcare.uu.se
authors.forename: Lena
authors.initials: L
authors.lastname: Gunningberg
authors.forename: Nancy
authors.initials: N
authors.lastname: Donaldson
authors.forename: Carolyn
authors.initials: C
authors.lastname: Aydin
authors.forename: Ewa
authors.initials: E
authors.lastname: Idvall
mesh_terms: D000368:Aged; D019985:Benchmarking; D005260:Female; D006769:Hospitals, General; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000451:nursing / Q000517:prevention & control; D015995:Prevalence; D019984:Quality Indicators, Health Care; D018570:Risk Assessment / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D014481:United States / Q000453:epidemiology