Influence of Unit-Level Staffing on Medication Errors and Falls in Military Hospitals

Abstract

This study examined unit-level associations of nurse staffing and workload, and the effect of the practice environment on adverse patient events. A secondary analysis was conducted of a longitudinal data set of 23 Army inpatient units from the Military Nursing Outcomes Database. Generalized Linear Mixed Modeling accommodated nested, nonparametric data. Staff category was found to be a significant predictor of medication errors and patient falls, but the relationship varied by unit type. Patient census had no effect on either outcome; however, a higher patient acuity was associated with an increase in both adverse events. The nursing practice environment mediated medication errors but not falls, in all unit types. Skill mix is important; however, additional components of staffing need consideration in producing positive patient outcomes.

An urban medical system's exploratory study of medication errors

“…This finding held for all inpatient nursing units where LPNs were used. The effect of complexity of diagnosis and increased errors has been found in other research (Breckenridge‐Sproat, Johantgen, & Patrician, ; Hall, Doran, & Pink, ).…”

Lower Nurse Staffing Levels Are Associated With Occurrences of Inpatient Falls at a Large Pediatric Hospital

“…In addition, Poisson regression would be the appropriate statistical method to use, rather than linear regression, when the objective is to fit a statistical model for which the dependent variable is a rate. 32 Although Breckenridge-Sproat et al 18 initially obtained data on the number of nursing HPPDs on the unit during the shift when falls occurred, the nursing HPPD data used for their statistical analysis were ''aggregated to the month level for each unit, resulting in a total number of 833 'unit-months','' and the relationship between nursing HPPDs and fall rate was examined using these 833 data points. Thus, a direct comparison of the nurse staffing level on the shifts when falls occurred to the shifts when falls did occur was not made, which might explain why Breckenridge-Sproat et al 18 did not find a relationship between units' number of nursing care HPPDs and the fall rate.…”

“…McGillis Hall et al 17 did not observe a relationship between nurse staffing and patient falls in a descriptive correlational study of 19 teaching hospitals. BreckenridgeSproat et al, 18 Blegen and Vaughn, 19 and Blegen et al 20 did not see a relationship between nurse staffing and patient falls when analyzing unit-level data aggregated over 1-month, 1-quarter, and 1-year periods, respectively. On the other hand, Sovie and Jawad 21 analyzed data from 29 teaching hospitals summarized over a 1-year period and found that more nursing hours per patient-day (HPPDs) were associated with lower fall rates.…”

Comparison of Nurse Staffing Measurements in Staffing-Outcomes Research

“…[2][3][4][5][6][7][8] Other studies, however, have not supported these inverse associations. [9][10][11][12] The inconsistent findings may result from differences in study designs (eg, longitudinal vs. cross-sectional), level of measurement (eg, hospital-level vs. unit-level), analytic methods (eg, descriptive vs. multivariate analysis), data sources, and techniques used for risk adjustment of patient outcome measures. Another potential reason for the inconsistency across studies is the variation in nurse staffing measures.…”