The On-Time Quality Improvement for Long-Term Care Program is funded by the Agency for Healthcare Research and Quality (AHRQ), generally in collaboration with a State Department of Health, a Quality Improvement Organization (QIO), or a trade association, to improve nursing home care. The focus is on prevention and timely treatment during routine care. New tools to document pressure ulcer healing and treatments and reports to help monitor the healing process have been developed as part of the expansion of the On-Time Quality Improvement Program.
Currently, there is a large amount of documentation and reporting in long-term care facilities related to pressure ulcer risk, pressure ulcer assessment, and treatment. But facilities have no standardized set of data elements to document weekly skin assessments and treatments provided. In addition, there are no easily accessible decision support tools. Existing tools consume large amounts of staff time but do not assist wound nurses and frontline clinicians in monitoring resident and pressure ulcer status and providing treatment based on best practice.
On-Time Pressure Ulcer Healing focused on monitoring pressure ulcer healing, risk factors that may be specific to the rate of healing, and best practices for treatment. The goal is to improve clinical information and integrate that information into facility daily workflow. Improved communication between certified nursing assistants (CNAs), dietary staff, Minimum Data Set (MDS) coordinators, social workers, and nurses should result in more timely referrals, treatments, and changes in care plans.
With the help of quality improvement consultants who conducted regular working phone meetings, facility staff work in multidisciplinary teams. Teams consolidate and standardize CNA documentation and ensure the completeness and accuracy of documentation. They use a set of reports and tracking tools to identify high-risk residents, improve information flow among team members, improve documentation of preventive care, and make more timely referrals and treatments. Reports can be accessed at least weekly and provide summary trend information.
Multidisciplinary On-Time implementation team members typically consisted of the nursing director, Quality Improvement Organization (QIO) coordinator/staff development director, nurses from the Skin Team, wound nurse, MDS nurse, and dietitian. Facility teams also participated in program phone meetings to share experiences with workflow transformation with other participating facilities. To foster learning, facilities also received educational opportunities that involved interaction with clinical experts via onsite visit and conference calls.
Materials and Tools
Literature Review: Review and summary of the existing evidence about treatments to improve pressure ulcer healing. The literature review provided the foundation for data elements included on the standardized wound assessment and informed the design of the clinical reports.
Wound assessment documentation and risk factor standardized forms: Includes core set of standardized data elements to capture details of pressure ulcer risk factors and treatments.
Prototype clinical report descriptions and calculations: Includes standardized wound assessment and treatment data elements. Designed to provide a comprehensive review of ulcer status, including duration of ulcer, treatments in place, detailed wound description, and healing progress.
Health information technology specifications:
Specifications for vendors to communicate data and reporting requirements.
Educational materials for using standardized documentation forms: Orient nurses to the standardized documentation forms and the clinical decisionmaking reports with explanations of use.
Current as of July 2009
On-Time Pressure Ulcer Healing Project. July 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/pressureulcerhealing/