Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Staff Response Time to Call Lights and Unit-Acquired Pressure Ulcer Rates in Adult In-Patient Acute Care Units

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Staff Response Time to Call Lights and Unit-Acquired Pressure Ulcer Rates in Adult In-Patient Acute Care Units

Article excerpt

The National Pressure Ulcer Advisory Panel (NPUAP, 2007) in the United States defines a pressure ulcer as 'localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. NPUAP classifies pressure ulcers - also called bed sores, pressure sores, or decubitus ulcers - into four stages, with two additional stages to describe deep tissue injury and unstageable pressure ulcers (NPUAP, 2007). NPUAP claims that most pres- sure ulcers are avoidable (Black et ah, 2011). The American Nurses Association, Inc. (ANA) has also responded to the overwhelming need for quality improvement initiatives relating to pressure ulcer prevention in hospital settings by including pres- sure ulcer-related indicators in the database of the National Database of Nursing Quality Indicators (e.g., percentage of surveyed patients with unit- acquired pressure ulcers stage II and greater) (ANA, 2008; Wurster, 2007).

Nurse staffing is often the process indica- tor that is first thought of and assumed to be linked to nursing-sensitive outcome indicators. Inconsistent findings were found between the relationship of nurse staffing and facility-acquired pressure ulcer rates (e.g., Lang, Hodge, Olson, Romano, & Kravitz, 2004; Pappas, 2008; Stone et al., 2007; Unruh, 2003; Unruh & Zhang, 2012). For example, the study conducted by Unruh (2003) found that the in-patient acute care units with a higher proportion of licensed nurses had a lower pressure ulcer rate. The study conducted by Stone et al. (2007) showed that the in-patient critical care units with higher nurse staffing had lower pressure ulcer rates based on the discharge codes of the patients with a length of stay of five or more days. In contrast, the study conducted by Pappas (2008) did not find a signif- icant relationship between registered nurse (RN) staffing and the occurrence of pressure ulcers. Regardless, ensuring adequate licensed nurse staff- ing should be a focused concern to hospital execu- tives. Identifying other nursing-process indicators that are objective (e.g., actual response time to call lights) and associated with unit-acquired pressure ulcer rates is desperately needed.

Study purpose

The purpose of this exploratory study was to examine the relationship between staff response time to call lights and the rate for unit-acquired pressure ulcers Stage II and greater in adult in-patient acute care units. Only the pressure ulcers acquired by patients during their stay at each one of the study units were included. NPUAP (2007) defines a stage II pressure ulcer as one that has 'partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough' and the wounds 'may also present as an intact or open/ruptured serum- filled blister'. Pressure ulcers stage II and greater all have an open wound (NPUAP, 2007).

The research question was: What is the rela- tionship between staff actual response time to call lights and the percentage of surveyed patients with unit-acquired pressure ulcers stage II and greater?

Background Pressure ulcers

Joint Commission Resources (2008) in the United States estimated that each year more than 2.5 million patients in US acute care settings expe- rience pressure ulcers. According to the report of the International Pressure Ulcer Prevalence Survey(TM), the hospital-acquired pressure ulcer prevalence in US in-patient acute care medical, surgical, medical-surgical units was 4.23% with a range from 4-4.4% among adult patients in 2009 (VanGilder, Arnlung, Harrison, & Meyer, 2009). Pressure ulcers may result in increased pain, prolonged infections, amputation, longer lengths of stay, and decreased quality of life (Joint Commission Resources, 2008).

Additional hospitalization costs of $2,384 per case were reported for medical patients with hospital-acquired pressure ulcers (Pappas, 2008). …

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