The Relationship of Nursing Preventive Measures and Hospital-Acquired Complications in Elderly Trauma Patients

Thursday, 25 July 2013: 8:50 AM

Christine Cutugno, PhD, RN, NEA-BC
Advanced Med-Surg Nursing, CNS program, APN and Nursing Administration Programs, Hunter-Bellevue School of Nursing, New York, NY

Learning Objective 1: 1. Describe the quality of life and financial burden to elderly trauma patients of preventable hospital-acquired complications.

Learning Objective 2: 2. Describe measures that maximize and hinder nursing performance of preventive measures for hospital-acquired complications.


The purpose of this research was to investigate the relationship between nursing preventive measures and hospital-acquired complications in elderly trauma patients.   The elderly are hospitalized at rates twice that of younger adults with similar injuries.  Their length of stay is longer and utilization of expensive resources is greater.  The incidence of adverse outcomes is the highest in this group and many complications are considered preventable with early assessment and intervention.  Nursing’s role in improving patient outcomes has been well documented but remains understudied in this group of patients.


        The health records of 179 trauma patients over 65 years of age discharged from a Level II trauma center were evaluated for nursing documentation of preventive measures, the incidence of hospital-acquired complications, and length of stay.  A monitoring tool was used to evaluate nursing documentation of preventive measures for mobility, respiratory and confusion assessment, skin integrity, fall prevention, hydration and incontinence management, urinary catheter care and pain control.  Presence of related complications (atelectasis, pneumonia, dehydration, falls with injuries, pressure ulcers, incontinence, urinary tract infection and confusion) were determined using standard ICD-9 complication codes. 


Data analysis indicated gaps in documentation of measures for respiratory and pain management, for the promotion of mobility, and for urinary catheter assessment and care.  Failure to document incontinence and urinary catheter assessments was associated with total complications and length of stay.


The most notable finding was that the preventive measures with the lowest documentation compliance (coughing and deep breathing, incentive spirometry, out of bed, and pain reassessment, urinary catheter assessment and catheter care) were those not required as mandatory entries in the electronic documentation system used by the hospital.  These findings point to the importance of the relationship between nursing documentation requirements and the electronic system used for the expedient documentation of care.