Sensitivity over nurse sensitive indicators

1 September 2012

Pressure injuries are one barometer for the quality of nursing care.

The level of pressure injuries are one of the so-called nurse sensitive indicators used in assessing whether a facility meet Magnet Hospital status.

Or as Chief Nurse Jane O’Malley puts it, in the absence of decent nursing staffing and good systems, pressure injury levels go up, and under good staffing and leadership, they go down.

While there is a direct link between good nursing, bad nursing, and pressure injury levels, there is also sensitivity to labeling pressure injury levels as a nurse sensitive indicator when other factors also come into play.

Nurse and ACC analyst Rachel Taylor says a fairly consistent theme in ACC claims for pressure injuries is a gap in patient care. So patient notes show no risk assessment, or an inappropriate assessment was done on the patient’s admission, or the assessment is done correctly but the needed special mattress never arrives, and five days later, a pressure ulcer is reported on the left heel.

“And you think, so what was happening in between times?

“It’s about consistently, across the board, doing the risk assessment, doing it correctly, putting a plan in place, following through on the plan, and if you can’t follow it through, putting another plan in place,” says Taylor.

“It’s that mindful, thoughtful nursing that says, ‘okay, I can’t get the mattress, but what can we do instead until we can get the mattress’ – those are where the gaps are coming.”

But nurses point out the gaps are not just by nurses.

“Pressure injuries are a painful, debilitating, and serious outcome of a failure of routine medical and nursing care,” says wound care nurse specialist Emil Schmidt.

Likewise, as wound nurse consultant Pam Mitchell puts it, “It is seen as a nurse sensitive indicator – it is actually an interdisciplinary indicator, not just a nurse one, but it lands at the nurses’ door”.