Risk factors associated with nursing-sensitive adverse events in older hospitalised patients: A retrospective chart review

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Background: Approximately 10% of hospitalised patients experience adverse events. Older patients are particularly vulnerable to developing nursing-sensitive adverse events such as pneumonia, urinary tract infections, pressure ulcers and delirium. However, various predictors which further increase their risk of acquiring such adverse events are not well understood. Objectives: To identify factors associated with nursing-sensitive adverse events in patients aged 65 and over in one acute Irish hospital and to determine the relationship between a nursing-sensitive adverse event, a patient's discharge destination and in-hospital mortality. Design: A retrospective study using healthcare chart data. Methods: A cohort of 1000 admissions of inpatients aged 65 and over who were discharged from a single university, tertiary hospital in Ireland in 2022 were included. A two-stage retrospective chart review was conducted on each of the 1000 admissions to extract data pertaining to their hospitalisation and to identify the presence of pneumonia, urinary tract infections, pressure ulcers and delirium. Univariate analysis was used to screen 13 collected variables to identify those with significant relationships with the nursing-sensitive adverse events. Variables with a p value of <0.25 were included in the multivariate analysis which was used to identify significant risk factors for any nursing-sensitive adverse event and each of the studied events in isolation. Results: A statistically significant association between medical speciality, an increase in age, length of stay, female sex, the number of diagnoses and procedures and a patient's admission situation and the nursing-sensitive adverse events investigated in this study was identified. Furthermore, time from first presentation to admission and number of ward moves were also associated with nursing-sensitive adverse events but yielded some contradictory findings. A significant association between in-hospital mortality and pressure ulcers was also identified. Patients who experienced nursing-sensitive adverse events were more likely to be discharged with home care packages or to be discharged to nursing homes, other hospitals, rehabilitation facilities or destinations within the 'other' category than be discharged home independently. Conclusions: This study offers valuable insights for the prevention of nursing-sensitive adverse events. Investment in strategies that are focused on medical patients, older patients, patients with multiple co-morbidities and those with longer lengths of stay is required to reduce nursing-sensitive adverse events. Further exploration of the association between waiting times from presentation to admission and ward moves and nursing-sensitive adverse events given that these factors may be potentially impacted by key nursing-modifiable interventions.

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