Patient and organisational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis

Abstract

ObjectivesTo 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.DesignMultilevel approach to data from 2 cross-sectional studies.Settings4 hospitals in Norway were studied.Participants1056 patients at 84 somatic wards.Primary outcome measureHAPU.ResultsSignificant 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/m2) (OR 0.32 (95% CI 0.17 to 0.62)).ConclusionsThe 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.

Predictors of hospital‐acquired pressure ulcers among older adult inpatients

“…In the PU group, 87.1% of the patients were over 70 years old. This supports the report that age over 70 years is an important indicator of PU occurrence (Bredesen et al, 2015). Age has already been reported as an important factor in PU occurrence in previous studies (Moore et al, 2015).…”

“…Several studies on PU predictors report a correlation between PU and gender (Nakamura et al, 2015), age (Bredesen, Bjoro, Gunningberg, & Hofoss, 2015;Moore et al, 2015), consciousness status (Iranmanesh, Rafiei, & Sabzevari, 2012), nutrition (Miller, Frankenfield, Lehman, Maguire, & Schirm, 2016), faecal and/or urine problem (Jenkins & O'Neal, 2010), pain (Skogestad et al, 2017), type of admission (Garcez Sardo et al, 2016) and mobility (Coleman et al, 2013). In particular, age over 70 years is a significant predictor (Bredesen et al, 2015). As PU substantially influences the health level and quality of life of older adult patients, the management of this condition is significantly important for older adult patients (Barry & Nugent, 2015).…”

“…To assess PU risks, screening tools should be used. The Braden Scale is the most widely used screening tool for PU risk with high validity (de Souza, Santos, Iri, & Sadasue Oguri, 2010), and the score obtained from the tool is a very important predictor (Bredesen et al, 2015;Mallah et al, 2015). Although the Braden Scale is a popular tool used by numerous hospitals, it does not propose concrete interventions, and data on its efficacy are insufficient (Moore et al, 2015;Vanderwee et al, 2011).…”

The pressure injury predictive model: A framework for hospital‐acquired pressure injuries

“…shown to be at an increased risk for HAPI. Schoonhoven et al, 2006;Raff et al, 2016;Slowikowski & Funk, 2010;Aljezawi et al, 2014;Connor, Sledge, Bryant-Wiersema, Stamm, & Potter, 2010;Corniello et al, 2014;Bredesen, Bjoro, Gunningberg, & Hofoss, 2015;Brito, Vasconcelos Generoso, & Correia, 2013;Skogestad et al, 2017;Sardo et al, 2016;Delmore et al, 2015;Cowan et al, 2012;Rao et al, 2016;Fred, Ford, Wagner, & VanBrackle, 2012;Hyun et al, 2014;Man & Au-Yeung, 2013;Saunders et al, 2012;Smit et al, 2016;Yoshimura et al, 2015;Demarre et al, 2015;Baumgarten et al, 2006;…”

“…-Admission total Braden score 21/24 -Lower total Braden scores increase the risk of PI development -Admission Braden score predictive of PI development Tschannen et al, 2012;Cremasco et al, 2013;Rao et al, 2016;Hayes et al, 2015;Delmore et al, 2015;Baldi et al, 2010;Hyun et al, 2014;Shahin et al, 2010;Cowan et al, 2012;Demarre et al, 2015;Miller et al, 2016;Raju et al, 2015;Slowikowski & Funk, 2010;Tescher et al, 2012;Corniello et al, 2014;Smit et al, 2016;Bredesen et al, 2015;Sardo et al, 2016;Connor et al, 2010;Coleman et al, 2013;Fred et al, 2012;Shaw et al, 2014 Episode of care…”