Medication Errors, Patient Falls and Pressure Ulcers: Improving Outcomes Over Time

Purpose:
To describe the efficacy of the Military Nursing Outcomes Database (MilNOD) as a viable patient safety initiative and to promote the MilNOD's replicable methodology as a nationwide sustainable and valid quality database to examine nurse staffing and improve hospitalized patient outcomes.

Background/Significance:
The MilNOD was created as both a performance improvement tool and research project to employ shift-level data collection of staffing, patient falls, medication administration errors and pressure ulcer prevalence, and supplied valid and reliable data to support the critical appraisal of staffing effectiveness and nursing's contribution to patient safety. It provided quarterly performance reports with data comparisons and dissemination of best practices across participating hospitals.

Methods:
Participants included a convenience sample of 47 inpatient units in 13 Army, Navy and Air Force hospitals who chose to implement MilNOD processes. Patient falls and nurse medication administration errors were extracted from hospital unusual occurrence reports. These data were collected monthly by on-site trained nurses, reported by the unit and expressed as the rate per 100 patient bed days. Pressure ulcer prevalence, defined as the proportion of all patients examined during a one-day prevalence survey with stage I, II, III, IV and unstageable ulcers, were collected by a team of on-site experts once or twice each year.

Results:
The MilNOD average nurse medication administration error rate significantly decreased from baseline to the 10th quarter of data collection (p = 0.019). On average, participating hospitals decreased the medication error rate by 55%. The MilNOD average patient falls rate decreased significantly over time (decrease of 69%, p = 0.028). The average hospital acquired pressure ulcer (HAPU) prevalence decreased significantly from baseline to the 4th prevalence survey (decrease of 62%, p = 0.036). In addition to significantly improved patient outcomes, participants experienced considerable cost avoidance (falls-$900,000/year; medication errors-$230,000/year; pressure ulcers-$450,000/year).

Conclusions and Implications for Practice:
The MilNOD was an efficient, replicable and sustainable patient safety initiative for inpatient acute care units. If MilNOD processes were incorporated as a standard business practice, the benefits would be expected to impact patient care quality and patient outcomes across entire health systems.