Nurse Continuity and Hospital-Acquired Pressure Ulcers: A Comparative Analysis Using an Electronic Health Record "Big Data" Set.
Nurse Continuity and Hospital-Acquired Pressure Ulcers: A Comparative Analysis Using an Electronic Health Record "Big Data" Set.
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DOI：
10.1097/nnr.0000000000000112
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发表时间：
2015-09
期刊：
影响因子：
2.5
通讯作者：
Keenan GM
中科院分区：
文献类型：
--
作者：
Stifter J;Yao Y;Lodhi MK;Lopez KD;Khokhar A;Wilkie DJ;Keenan GM
很少有研究表明，护士的连续性对病人的结果的影响，尽管直觉上认为，护理的连续性使护理结果的差异。检查护士连续性（相同/一致RN的连续护理天数）对预防医院获得性压疮（HAPU）的影响。本比较研究使用了Hands on Automated Nursing Data System（HANDS）的数据。HANDS是一个护理计划（POC）“大数据”数据库，包含由4家医院9个单位的787名护士记录的42，403次事件，包括护士人员配备和患者特征。通过数据挖掘，我们创建了840个护理事件的分析数据集，其中210个有HAPU，630个没有HAPU，与护理单元，患者年龄和患者特征相匹配。Logistic回归分析确定了护士连续性和额外的护士人员配置变量对HAPU存在的影响。在所有9个研究单位均观察到护士连续性较差（连续性指数=.21-.42 [1.0 =最佳连续性]）。入院时的营养、活动、灌注、水合作用和皮肤问题以及患者年龄与HAPU相关（p <0.001）。控制病人的特点，护士的连续性和护士的连续性和其他护士人员配置变量之间的相互作用与HAPU的发展没有显着相关。患者的营养、活动性和灌注等特征与HAPU相关，但护士的连续性与HAPU无关。一项研究表明，为了减少HAPU的发生率，最有效的资源利用可能是继续开发最佳实践，以解决导致压疮脆弱性的患者特征，而不是关注护士人员配备。
There is little research demonstrating the influence of nurse continuity on patient outcomes despite an intuitive belief that continuity of care makes a difference in care outcomes. To examine the influence of nurse continuity (the number of consecutive care days by the same/consistent RN[s]) on the prevention of hospital-acquired pressure ulcers (HAPU). A secondary use of data from the Hands on Automated Nursing Data System (HANDS) was performed for this comparative study. The HANDS is a nursing plan of care (POC) “big data” database containing 42,403 episodes documented by 787 nurses, on 9 units, in four hospitals and includes nurse staffing and patient characteristics. Via data mining, we created an analytic dataset of 840 care episodes, 210 with and 630 without HAPUs, matched by nursing unit, patient age, and patient characteristics. Logistic regression analysis determined the influence of nurse continuity and additional nurse-staffing variables on the presence of HAPUs. Poor nurse continuity (Continuity Index=.21-.42 [1.0=optimal continuity]) was noted on all nine study units. Nutrition, mobility, perfusion, hydration, and skin problems on admission as well as patient age were associated with HAPUs (p<.001). Controlling for patient characteristics, nurse continuity and the interactions between nurse continuity and other nurse-staffing variables were not significantly associated with HAPU development. Patient characteristics including nutrition, mobility, and perfusion were associated with HAPUs, but nurse continuity was not. One study implication is that to reduce the incidence of HAPUs the most effective resource utilization might be in the continued development of best practices to address patient characteristics that lead to pressure ulcer vulnerability rather than a focus on nurse staffing.