title: Patient and organisational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis.
abstract: OBJECTIVE
  To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors.
  
  
  METHODS
  Multilevel approach to data from 2 cross-sectional studies.
  
  
  METHODS
  4 hospitals in Norway were studied.
  
  
  METHODS
  1056 patients at 84 somatic wards.
  
  
  METHODS
  HAPU.
  
  
  RESULTS
  Significant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age >70 vs <70 (OR 2.70 (95% CI 1.54 to 4.74)), Braden scale total score (OR 0.73 (95% CI 0.67 to 0.80)) and overweight (body mass index 25-29.99 kg/m(2)) (OR 0.32 (95% CI 0.17 to 0.62)).
  
  
  CONCLUSIONS
  The fact that the odds of HAPU varied across wards, and that across-ward variance was reduced when the selected ward-level variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients.
authors: Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
authors: Ida Marie
authors: IM
authors: Bredesen
authors: Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
authors: Karen
authors: K
authors: Bjøro
authors: Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.
authors: Lena
authors: L
authors: Gunningberg
authors: Institute of Health and Society, University of Oslo, Oslo, Norway.
authors: Dag
authors: D
authors: Hofoss
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D006757:Hospital Units / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D055361:Multilevel Analysis; D009664:Norway / Q000453:epidemiology; D015279:Organizational Culture; D050177:Overweight / Q000150:complications; D061214:Patient Safety / Q000592:standards*; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D015995:Prevalence; D012307:Risk Factors