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DOI: 10.4338/ACI-2011-07-RA-0046
Evaluation of the Pressure Ulcer Prevention Clinical Decision Report for Bedside Nurses in Acute Care Hospitals
Correspondence to:
Publication History
received:
21 July 2011
accepted:
25 October 2011
Publication Date:
16 December 2017 (online)
Summary
Background: Hospital stays for patients with pressure ulcers (PU) increased nearly 80% from 1992 to 2006. Most PU’s developed during an admission, often despite preventive efforts from clinical staff. Data from Electronic medical records (EMR’s) were used to prepare daily patient risk factor and PU information for nurses to help prevent PU development and exacerbations.
Objectives: The objectives of this study were to determine whether: 1) dissemination of an automated daily report with patient risk and current status of pressure ulcers (“PU Daily”) helps prevent the development of pressure ulcers, and 2) using the PU Daily information impacts the severity of pressure ulcers that develop in an acute care setting.
Methods: A pre-post study with four control units was designed to determine the impact of the PU Daily in intensive care units (ICU) in a large medical center. The control units included ICU’s using the same EMR and similar complexity of cases with a high risk of developing a PU. The pre-post study took place over a six month period (March – August 2009).
Results: A total of 6,735 cases were included in the study. The intervention unit showed a significant decrease (p = 0.004) in PU’s at post-evaluation; none of the four comparison units showed a decrease at the p<0.05 level. The intervention led to a significant reduction in the total number of PU’s documented (p <0.000) and the number of Stage II PU’s (p = 0.046).
Conclusion: The intervention with the PU Daily showed a significant decrease in the total PU’s and severity of PU’s and allowed for implementation of interventions that help prevent the development of PU’s. As EMR’s become more widely available, this intervention showed a reduction in PU’s. Future studies should further develop this intervention and include multiple institutions and patient populations.
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Conflict of Interest
The authors declare that they have no conflicts of interest in the research.
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References
- 1 National Pressure Ulcer Advisory Panel.. Pressure ulcer stages revised by the National Pressure Ulcer Advisory Panel. Ostomy Wound Manage 2007; 53 (03) 30-31.
- 2 Armstrong DG, Ayello EA, Capitulo KL, Fowler E, Krasner DL, Levine JM. et al. New opportunities to improve pressure ulcer prevention and treatment: Implications of the CMS Inpatient Hospital Care Present on Admission (POA) Indicators/Hospital-Acquired Conditions (HAC) Policy. J Wound Ostomy Continence Nur 2008; 35 (05) 485-492.
- 3 Clarke HF, Bradley C, Whytock S, Handfield S, vander Wal R, Gundry S. Pressure ulcers: Implementation of evidence-based nursing practice. J Adv Nurs 2005; 49 (06) 578-590.
- 4 California Healthcare Foundation.. Trendspotting: How it triggers better care in nursing homes. September 2011, 1–8. Available from: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDFT/PDF%20TrendspottingTriggersBetterCareNursingHomes.pdf.
- 5 O’Reilly M, Talsma AN, Van Riper S, Kheterpal S, Burney R. An anesthesia information system to provide physician specific feedback improves timely administration of prophylactic antibiotics. Anesth Anal 2006; 103 (04) 908-912.
- 6 Wahl WL, Talsma AN, Dawson C, Dickinson S, Pennington K. Wilson et al. Use of computerized ICU documentation to capture ICU core measures. Surgery 2006; 140 (04) 684-689.
- 7 American Nurses Association.. National Database of Nursing Quality Indicators, 2011. American Nurses Association, Silver Springs, MD. Available from: https://www.nursingquality.org.
- 8 Teigland C, Gardiner R, Li H, Byrne C. Clinical Informatics and its usefulness for assessing risk and preventing falls and pressure ulcers in nursing home environments. In Henriksen K, Battles JB, Marks ES, Lewin DI. editors. Advances in Patient Safety: From research to implementation (Volume 3: Implementation Issues) Rockville, MD: Agency for Healthcare Research and Quality (US). 2005
- 9 VanGilder C, Amlung S, Harrison P, Meyer S. Results of the 2008–2009 International Pressure Ulcer prevalence™ Survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Management 2009; 55 (11) 39-45.
- 10 Russo CA, (Thomson Reuters) Steiner C, (AHRQ) and Spector W. (AHRQ) Hospitalizations Related to Pressure Ulcers, 2006. HCUP Statistical Brief #64. December 2008. Agency for Healthcare Research and Quality, Rockville, MD. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb64.pdf.
- 11 Maeda JL, Parlato J, Levit K, Andrews RM, Jiang HJ. Hospital-acquired conditions in selected community hospitals from 15 states. AHRQ Statistical Brief #118; 2008; 2011. Agency for Healthcare Research and Quality, Rockville, MD. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb118.pdf.
- 12 U.S. Department of Health and Human Services, HealthCare.gov. Pressure Ulcers; 2011. U. S. Department of Health and Human Services, Washington, D. C. Available from: http://www.healthcare.gov/center/pro grams/partnership/resources/ulcers.html.
- 13 Lyder CH, Ayello EA. Chapter 12. Pressure ulcers: a patient safety issue. Patient safety and quality: An evidenced-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality 2008
- 14 Agency for Healthcare Research and Quality. Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care, Section 7. Tools and Resources. Available from: http://www.ahrq.gov/research/ltc/pressureulcertoolkit/putoolssect7.pdf.
- 15 Bergstrom N, Braden BJ, Laquzza A, Holman V. The Braden scale for predicting pressure sore risk. Nurs Res 1987; 36 (04) 205-210.
- 16 Centers for Medicare and Medicaid Services (CMS), HHS. Medicare program; changes to the hospital in-patient prospective payment system for acute care hospitals and fiscal year 2010 rates; and changes to the long-term care hospital prospective payment system and rate years 2010 and 2009 rates. Final rules and interim final rule with comment period. Fed Registrar. 2009;74:43753–44236, Centers for Medicare and Medicaid Services, Baltimore, MD. Available from: http://www.federalregister.gov/articles/2009/08/27/E9–18663/medicare-program-changes-to-the-hospital-inpatient-prospective-payment-systems-for-acute-care.
- 17 Tschannen D, Talsma A, Gombert J, Mowry J. Using the TRIP model to disseminate an IT-based pressure ulcer intervention. West J Nurs Res 2011; 33 (03) 427-442.
- 18 Kottner J, Dassen T. Pressure ulcer risk assessment in critical care: Interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units. Int J Nurs Stud 2010; 47 (06) 671-677.
- 19 SAS Institute Inc. What’s New in SAS 9.0., 9l1, 9.1.2 and 9.1.3. Cary, NC: SAS Institute Inc; 2004
Correspondence to:
-
References
- 1 National Pressure Ulcer Advisory Panel.. Pressure ulcer stages revised by the National Pressure Ulcer Advisory Panel. Ostomy Wound Manage 2007; 53 (03) 30-31.
- 2 Armstrong DG, Ayello EA, Capitulo KL, Fowler E, Krasner DL, Levine JM. et al. New opportunities to improve pressure ulcer prevention and treatment: Implications of the CMS Inpatient Hospital Care Present on Admission (POA) Indicators/Hospital-Acquired Conditions (HAC) Policy. J Wound Ostomy Continence Nur 2008; 35 (05) 485-492.
- 3 Clarke HF, Bradley C, Whytock S, Handfield S, vander Wal R, Gundry S. Pressure ulcers: Implementation of evidence-based nursing practice. J Adv Nurs 2005; 49 (06) 578-590.
- 4 California Healthcare Foundation.. Trendspotting: How it triggers better care in nursing homes. September 2011, 1–8. Available from: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDFT/PDF%20TrendspottingTriggersBetterCareNursingHomes.pdf.
- 5 O’Reilly M, Talsma AN, Van Riper S, Kheterpal S, Burney R. An anesthesia information system to provide physician specific feedback improves timely administration of prophylactic antibiotics. Anesth Anal 2006; 103 (04) 908-912.
- 6 Wahl WL, Talsma AN, Dawson C, Dickinson S, Pennington K. Wilson et al. Use of computerized ICU documentation to capture ICU core measures. Surgery 2006; 140 (04) 684-689.
- 7 American Nurses Association.. National Database of Nursing Quality Indicators, 2011. American Nurses Association, Silver Springs, MD. Available from: https://www.nursingquality.org.
- 8 Teigland C, Gardiner R, Li H, Byrne C. Clinical Informatics and its usefulness for assessing risk and preventing falls and pressure ulcers in nursing home environments. In Henriksen K, Battles JB, Marks ES, Lewin DI. editors. Advances in Patient Safety: From research to implementation (Volume 3: Implementation Issues) Rockville, MD: Agency for Healthcare Research and Quality (US). 2005
- 9 VanGilder C, Amlung S, Harrison P, Meyer S. Results of the 2008–2009 International Pressure Ulcer prevalence™ Survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Management 2009; 55 (11) 39-45.
- 10 Russo CA, (Thomson Reuters) Steiner C, (AHRQ) and Spector W. (AHRQ) Hospitalizations Related to Pressure Ulcers, 2006. HCUP Statistical Brief #64. December 2008. Agency for Healthcare Research and Quality, Rockville, MD. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb64.pdf.
- 11 Maeda JL, Parlato J, Levit K, Andrews RM, Jiang HJ. Hospital-acquired conditions in selected community hospitals from 15 states. AHRQ Statistical Brief #118; 2008; 2011. Agency for Healthcare Research and Quality, Rockville, MD. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb118.pdf.
- 12 U.S. Department of Health and Human Services, HealthCare.gov. Pressure Ulcers; 2011. U. S. Department of Health and Human Services, Washington, D. C. Available from: http://www.healthcare.gov/center/pro grams/partnership/resources/ulcers.html.
- 13 Lyder CH, Ayello EA. Chapter 12. Pressure ulcers: a patient safety issue. Patient safety and quality: An evidenced-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality 2008
- 14 Agency for Healthcare Research and Quality. Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care, Section 7. Tools and Resources. Available from: http://www.ahrq.gov/research/ltc/pressureulcertoolkit/putoolssect7.pdf.
- 15 Bergstrom N, Braden BJ, Laquzza A, Holman V. The Braden scale for predicting pressure sore risk. Nurs Res 1987; 36 (04) 205-210.
- 16 Centers for Medicare and Medicaid Services (CMS), HHS. Medicare program; changes to the hospital in-patient prospective payment system for acute care hospitals and fiscal year 2010 rates; and changes to the long-term care hospital prospective payment system and rate years 2010 and 2009 rates. Final rules and interim final rule with comment period. Fed Registrar. 2009;74:43753–44236, Centers for Medicare and Medicaid Services, Baltimore, MD. Available from: http://www.federalregister.gov/articles/2009/08/27/E9–18663/medicare-program-changes-to-the-hospital-inpatient-prospective-payment-systems-for-acute-care.
- 17 Tschannen D, Talsma A, Gombert J, Mowry J. Using the TRIP model to disseminate an IT-based pressure ulcer intervention. West J Nurs Res 2011; 33 (03) 427-442.
- 18 Kottner J, Dassen T. Pressure ulcer risk assessment in critical care: Interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units. Int J Nurs Stud 2010; 47 (06) 671-677.
- 19 SAS Institute Inc. What’s New in SAS 9.0., 9l1, 9.1.2 and 9.1.3. Cary, NC: SAS Institute Inc; 2004