1.3. Study objective
The study objective was to develop a composite indicator that combines hospital-acquired pressure ulcer rate and total fall rate in order to take a step toward having a broader view of unit nursing care quality.
We conducted the Pressure Ulcer and Fall Rate Quality Composite Index development in two phases (see Fig. 1 for Flow Chart of Study Phases). In Phase 1 we developed the Pressure Ulcer and Fall Rate Quality Composite Index formula using a utility function – which assigns numerical values to different changes in the two quality measures of hospital-acquired pressure ulcer rate and total fall rate – and generalized penalty analysis. Higher scores on the Pressure Ulcer and Fall Rate Quality Composite Index indicate better outcomes.
In Phase 2 we obtained beginning evidence of validity for the Pressure Ulcer and Fall Rate Quality Composite Index by examining relationships of the Pressure Ulcer and Fall Rate Quality Composite Index scores to “other variables that the test is expected to correlate with or predict, as well as variables that the test is not expected to correlate with” (Goodwin, 2002). We hypothesized that
1. A higher percentage of unit registered nurses with a baccalau- reate in nursing or higher degree, a higher unit percentage of registered nurses holding certification in a specialty area of nursing practice, higher unit total nursing hours per patient day, and higher unit registered nurse skill mix will be associated with higher unit Pressure Ulcer and Fall Rate Quality Composite Index scores;
2. The unit percent of nursing hours supplied by agency staff will not be associated with unit Pressure Ulcer and Fall Rate Quality Composite Index scores;
3. A higher percentage of unit patients at risk for a hospital- acquired pressure ulcer will be associated with lower unit Pressure Ulcer and Fall Rate Quality Composite Index scores;
4. A higher percentage of unit patients assessed for pressure ulcer risk in the 24-h period before the hospital-acquired pressure ulcer assessment and higher unit mean number of pressure ulcer prevention measures in place per patient will be associated with higher unit Pressure Ulcer and Fall Rate Quality Composite Index scores; and
5. Higher unit restraint rate will be associated with lower unit Pressure Ulcer and Fall Rate Quality Composite Index scores.