title: 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 HAPUs.
  
  
  METHODS
  Seven hundred and eighty-nine medical-surgical units (215 hospitals) in 2009.
  
  
  METHODS
  Using unit-level data, HAPUs were modeled with Poisson regression with zero-inflation (due to low prevalence of HAPUs) with significant covariates as predictors.
  
  
  METHODS
  Hospitals submitted data on NQF endorsed ongoing performance measures to CALNOC registry.
  
  
  RESULTS
  Fewer HAPUs 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.
authors.affiliation: Cedars-Sinai Medical Center and Burns and Allen Research Institute, 8700 Beverly Blvd., Los Angeles, CA; Collaborative Alliance for Nursing Outcomes, San Ramon, CA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Aydin
authors.forename: Nancy
authors.initials: N
authors.lastname: Donaldson
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Stotts
authors.forename: Moshe
authors.initials: M
authors.lastname: Fridman
authors.forename: Diane Storer
authors.initials: DS
authors.lastname: Brown
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D005260:Female; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000453:epidemiology*; D015995:Prevalence; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D016526:Workload / Q000706:statistics & numerical data*
keywords: Nursing; acute inpatient care; modeling; quality of care/patient safety (measurement)