To determine if educating nursing home staff about pressure ulcer prevention reduces the differential risk of pressure ulcer development in black and white nursing home residents.
Subanalysis of a study designed to monitor the emergence of all pressure ulcers in nursing home residents during 12-week baseline and intervention periods.
All residents and staff of a not-for-profit, 136-bed nursing home in urban western Pennsylvania.
The quality improvement intervention, featuring a computer-based interactive video education program on pressure ulcer prevention and early detection, consisted of 3 components: (1) staff ability enhancement, (2) staff financial incentives, and (3) real-time management feedback. Three specific outcome measures were monitored for differential risk of pressure ulcer development in black and white nursing home residents: (1) the rate of emergent Stage I-IV pressure ulcers identified, (2) the rate of emergent Stage II-IV pressure ulcers identified, and (3) the rate of individual residents developing at least 1 pressure ulcer (Stages II-IV).
At baseline, black residents demonstrated a higher rate of Stage II-IV pressure ulcer emergence. Black residents with any pressure ulcer were also more likely to have multiple Stage II pressure ulcers compared with white residents. During the baseline period, 31.8% of the pressure ulcers detected in white residents were Stage I, whereas no Stage I pressure ulcers were detected in black residents. During the intervention period, the rate of emergence of all pressure ulcers declined for both groups in similar trends.
Black residents were more likely to have multiple Stage II-IV pressure ulcers and were less likely to have Stage I pressure ulcers identified at baseline compared with white residents. The education intervention effectively reduced the rate of pressure ulcers for all residents and eliminated the racial disparity noted during the baseline period.
[Show abstract][Hide abstract] ABSTRACT: Objective: The Patient Safety Indicators (PSIs) developed by the Agency for Healthcare Research and Quality identify potential patient safety events through administrative records. We sought to determine whether there were racial disparities in patient safety event rates in Veterans Health Administration (VHA) hospitals. Methods: We explored 5 years of VHA inpatient data for significant differences between racial/ethnic groups in their odds of experiencing PSIs. Results: No racial group had consistently higher or lower odds of experiencing PSIs. For example, African Americans had significantly higher odds of decubitus ulcer (OR = 1.35, P < 0.0001) and postoperative pulmonary embolism (PE)/deep vein thrombosis (DVT) (OR = 1.23, P < 0.0001) but significantly lower odds of accidental puncture or laceration (OR = 0.69, P = 0.0003) compared with whites. Conclusion: Although significant differences between racial/ethnic groups in the odds of experiencing PSIs were few, the underlying causes of the disparities that were found must be explored to understand how they can be eliminated and to improve patient safety for all patients.
Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment), Edited by Kerm Henriksen, James B Battles, Margaret A Keyes, Mary L Grady, 01/2008; Agency for Healthcare Research and Quality.
[Show abstract][Hide abstract] ABSTRACT: The past few decades have seen increasing concern about the quality of nursing home (NH) care. As with other health care sectors, NHs have attempted to embrace a culture of safety, but the additional barriers that they face place the NH industry at a distinct disadvantage. In this review, we provide a summary of current models of NH quality and an overview of two important clinical areas for quality improvement: pressure ulcers and falls. Despite heavy regulation of the NH industry, hoped-for improvements in quality have been limited. We argue that systemic barriers, such as staffing shortages, NH organization, and an adversarial regulatory environment, preclude advances in NH quality.
Annual Review of Public Health 02/2008; 29(1):369-82. DOI:10.1146/annurev.publhealth.29.020907.090912 · 6.47 Impact Factor
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