Prevention Of Nursing Adverse Events In Hospital Setting Based On Risk Management Theory

Background and PurposeThis research aims to explore the mechanisms,predisposing factors,and early indications of nursing risks.We attempted to identify independent risk factors for falls and hospital-acquired pressure ulcers,and develop a prediction model using a scoring system for patients in general three-classed hospital setting.Methods1.Risk identification and assessment: A retrospective case-control of hospitalized patients who fell or had hospital-acquired pressure ulcer was conducted at the Second Affiliated Hospital of Harbin Medical University.This study included inpatient falls and hospital-acquired pressure ulcers that were reported into the hospital’s online adverse event reporting system from January 2013 through December 2014.According to inclusion and exclusion criteria,a total of 594 cases of nursing of adverse events,including 98 inpatients fell and 496 had hospital-acquired pressure ulcers.318 controls matched inpatients that fell and 480 controls matched inpatients that had hospital-acquired pressure ulcer on approximate length of stay until the index adverse events.A data collection instrument was developed based on literature,nursing risk assessment scales and related clinical nursing practice guidelines,contained potential risk factors including patient-related,clinical intervention,health status,and unit-related variables.Data on potential risk factors of the adverse events were collected via adverse event reports,medical records,and nursing records.χ2 test was used to compare characteristics for categorical variables.Multiple logistic regression analysis was employed to develop prediction models forfalls and hospital-acquired pressure ulcer.The prediction model for adverse events was developed from the results of the multivariate analysis.The predictive score was calculated by odds ratio-based scoring method.The discriminative powers of the models were evaluated by receiver-operating characteristic area under the curve analysis as well as Youden Index.2.Developing risk control measures: Systematic review and meta-analysis were applied to determine the effectiveness of multi-displine intervention for falls and hospital-acquired pressure ulcer.Results1.There were 667 cases of nursing adverse events during 2013-2014,98 falls and 496 hospital-acquired pressure ulcers,which two made up 89.1% of all adverse events.The fall rate was 0.03%,and the rate of hospital-acquired pressure ulcer was 0.15%.The average age of the patients was(63.1±14.3)years,with346 males(58.2%)and 248 females(41.8%).2.According to univariate analysis,20 variables were significantly associated with falls.Multiple logistic regression analysis showed that age > 60 yrs,gait/balance deficit,history of falls,frequent urinate,impairment of consciousness,higher Charlson Comorbidity Index score,antidiabetic agents,sedation,use 2 or more high risk medications,patient-nurse ratio < 1:0.4 were identified as significant predictors for falls.According to univariate analysis,19 factors were significantly associated with hospital-acquired pressure ulcer.Multiple logistic regression analysis showed that age,thin/obesity,Braden scale score,surgery or trauma,incontinence associated dermatitis were identified as significant predictors for hospital-acquired pressure ulcer.High temperature,Braden scale score,indwelling urinary catheter,friction/shear stress issues,incontinence associated dermatitis and skin color changes are risk factors of pressure ulcer in patients with skin breakage.Based on the logistic regression models were established inpatient falls risk prediction model,hospitalizedpatients at various stage of pressure ulcer risk early-warning model and II~IV and uncertain stage of pressure sore risk early-warning model.3.Meta-analysis and systematic review showed that multi-displined nursing intervenes could reduce the rates of falls and hospital-acquired pressure ulcer.Based on the evidence,nursing intervene strageies were developed for reducing falls and hospital-acquired pressure ulcer.ConclusionPatient-related characteristics as well as patient health status,care-related factors and unit features could increase the risk of nursing adverse events.The logistic regression model fit well,the scoring system described in this study will be useful for clinicians to choose effective preventive interventions for high-risk patients.