Evaluation of patient safety culture surveys as a Prognostic Tool in hospital-acquired pressure ulcers

Abstract

Background: Hospital-acquired pressure ulcers are a widely tracked nurse-sensitive adverse event, and their prevention depends on reliable unit-level processes such as risk assessment, repositioning, and early escalation, behaviors that safety culture theory holds are shaped by teamwork, communication, and non-punitive reporting.

Objective: This review evaluates whether patient safety culture survey scores, principally the AHRQ Hospital Survey on Patient Safety Culture, have demonstrated prognostic value for hospital-acquired pressure ulcer incidence, and where that evidence remains limited.

Methods: We synthesized survey validation studies, nurse-sensitive outcome research, and studies directly linking safety culture composite scores to pressure ulcer incidence, alongside the established Braden Scale risk-assessment literature used as a comparator.

Findings: Composite culture scores show a consistent, moderate inverse association with pressure ulcer incidence, strongest for teamwork and management-support domains, but culture score alone explains less outcome variance than the Braden Scale, and combined models modestly outperform either input alone; most studies remain cross-sectional.

Conclusions: Safety culture surveys carry real but complementary, not standalone, prognostic value for pressure ulcer risk, and are best used alongside patient risk assessment, adequate staffing, and structured prevention bundles rather than as a substitute for them.