Inpatient falls and pressure ulcers as nursing quality indicators in national benchmarking-a retrospective observational registry study.

Abstract

Background: Collecting data of quality of care and using these data in research and in developing clinical practice has become more systematic worldwide. Globally, one of the goals is to advance benchmarking nursing-sensitive quality of care between healthcare organizations. Inpatient falls and hospital-acquired pressure ulcers are widely used as nursing-sensitive quality indicators in benchmarking, as they are related to additional healthcare costs and the decrease in patients' quality of life. The aim of this study was to explore the prevalence of inpatient falls and hospital-acquired pressure ulcers among adult patients in Finnish acute and psychiatric care based on national nursing-sensitive benchmarking data.

Methods: The retrospective observational registry study was conducted in Finnish adult inpatient units in acute and psychiatric care between 2021 and 2022. The benchmarking data of inpatient falls covered 10 hospitals and hospital-acquired pressure ulcer data covered 11 hospitals. Frequencies and percentages were used to describe the results.

Results: The data of inpatient falls covered a total of 2 518 152 patient days (per month min 70 581; max 122 628) and the data included 4526 falls. Of them, the number of falls with an injury was 1866 (41%), totalling 0.74 falls with an injury per 1000 patient days. In the hospital-acquired pressure ulcer data, there were 48 155 patients. Of them, 88% (n = 42 402) had their skin condition visually assessed from head-to-toe. A total of 3214 (7.6%) patients had pressure ulcers, of which 1917 (4.5%) were hospital-acquired pressure ulcers. The prevalence of hospital-acquired pressure ulcers in Stages 2-4 was 1.4% (n = 579). The highest inpatient fall rate was in psychogeriatric units, whereas the highest hospital-acquired pressure ulcer rate was in intensive care units.

Conclusion: The low prevalence rates of inpatient falls and hospital-acquired pressure ulcers indicate that the quality of nursing care in Finland is on a good level when compared to international research findings. However, there is still room for improvement, especially in units with a high number of adverse events. Results provide information about nursing care quality to further develop clinical practice. The experiences and principles obtained in benchmarking nursing quality can be utilized in creating an official national quality register for nursing-sensitive quality indicators.