The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: A cross-sectional study

Background Pressure ulcers are preventable adverse events. Organizational differences may influence the quality of prevention across wards and hospitals. Objective To investigate the prevalence of pressure ulcers, patient-related risk factors, the use of preventive measures and how much of the pressure ulcer variance is at patient, ward and hospital level. Design A cross-sectional study. Setting Six of the 11 invited hospitals in South-Eastern Norway agreed to participate. Participants Inpatients ≥18 years at 88 somatic hospital wards (N = 1209). Patients in paediatric and maternity wards and day surgery patients were excluded. Methods The methodology for pressure ulcer prevalence studies developed by the European Pressure Ulcer Advisory Panel was used, including demographic data, the Braden scale, skin assessment, the location and severity of pressure ulcers and preventive measures. Multilevel analysis was used to investigate variance across hierarchical levels. Results The prevalence was 18.2% for pressure ulcer category I–IV, 7.2% when category I was excluded. Among patients at risk of pressure ulcers, 44.3% had pressure redistributing support surfaces in bed and only 22.3% received planned repositioning in bed. Multilevel analysis showed that although the dominant part of the variance in the occurrence of pressure ulcers was at patient level there was also a significant amount of variance at ward level. There was, however, no significant variance at hospital level. Conclusions Pressure ulcer prevalence in this Norwegian sample is similar to comparable European studies. At-risk patients were less likely to receive preventive measures than patients in earlier studies. There was significant variance in the occurrence of pressure ulcers at ward level but not at hospital level, indicating that although interventions for improvement are basically patient related, improvement of procedures and organization at ward level may also be important