Relationship of Wound, Ostomy, and Continence Certified Nurses and Healthcare-Acquired Conditions in Acute Care Hospitals
Reducing healthcare-acquired conditions (HACs), such as hospital-acquired pressure injuries (HAPIs) and catheter-associated urinary tract infections (CAUTIs), is an important strategy for improving patient outcomes and decreasing costs in acute care hospitals. Both adverse events are part of US healthcare policy and patient safety initiatives, including the Centers for Medicare & Medicaid Services (CMS) nonpayment to hospitals for the extra cost of treating these events.
Numerous patients receiving care in acute care facilities in the United States develop HAPIs; the annual estimated cost of HAPI care is $9.1 billion to $11.6 billion. Bergquist-Beringer and colleagues3 reported a 3.6% HAPI rate among all surveyed inpatients and 7.9% among those at risk. Patients who develop HAPIs experience pain, have lower health-related quality of life, and are more likely to die during a hospital stay.
Urinary tract infections are the most common hospital-acquired infection and about 80% are catheter-associated. Lo and associates reported that the daily risk of acquiring a urinary tract infection varies from 3% to 7% when an indwelling catheter is in place. Although the cost per case of CAUTI, ranging from $862 to $1007, is low relative to other HACs, the total financial burden for hospitals due to nonreimbursement is substantial. Other costs of CAUTI, such as patient discomfort, restricted activities of daily living, loss of dignity, potential for venous thromboembolism, and HAPI, have not been quantified.7
WOC certified nurses are prepared to improve the level and quality of care (acute and rehabilitative) for people with selected disorders of the integumentary, genitourinary, and gastrointestinal systems. WOC certified nurses are RNs who are credentialed by the Wound, Ostomy, and Continence Nursing Certification Board in 1 or more specialty areas of wound, ostomy and continence care. Although evidence exists in studies using large samples about the effectiveness of WOC certified nurses in improving home healthcare outcomes (including urinary incontinence and pressure injuries) at both the individual patient care and agency level, little is known about the relationship between WOC certified nurses and HACs in acute care hospitals.
Using a large sample of acute care hospitals from the National Database of Nursing Quality Indicators (NDNQI), our study aims were to (1) determine the numbers and types of WOC certified nurses employed in NDNQI hospitals, (2) compare the characteristics of NDNQI hospitals that do and do not employ WOC certified nurses, (3) describe HAPI rates and HAPI risk and prevention interventions in NDNQI hospitals that do and do not employ WOC nurses with wound care specialty certification, (4) examine the association between WOC nurses with wound care specialty certification and HAPI rates, (5) describe CAUTI rates in NDNQI hospitals that do and do not employ WOC nurses with continence and/or ostomy care specialty certification, and (6) examine the association between nurses with continence and/or ostomy care specialty certification and CAUTI rates. For this study, we included WOC nurses with the following specialty certifications: CWOCN (certified wound, ostomy and continence nurse), CWCN (certified wound care nurse), CWON (certified wound ostomy nurse), CCCN (certified continence care nurse), and COCN (certified ostomy care nurse). COCNs were included in the study because they may have been the only WOC certified nurse in a hospital. HAPI prevention interventions included skin assessment, redistribution surface use, repositioning, nutritional support, and moisture management. Hospital-acquired pressure injury and CAUTI rates included the total HAPI rate, HAPI stage 2 and higher rate, HAPI stages 3 and 4 rate, and the total CAUTI rate.
For purposes of this study, we assumed that WOC certified nurses influence nursing interventions and patient outcomes through several mechanisms. This assumption is based on their provision of direct care, education, and consultation to patients. In addition, they provide consultation and direction to non-WOC certified nurses. They also may be involved in developing procedures, guidelines, and protocols for patient care, as well as select supplies, beds, and the like. <<<Read More>>>