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Table 4.1. Sample Pressure Ulcer Trigger Summary Report: Resident-Level Section

On-Time Quality Improvement Manual for Long-Term Care Facilities

Name

Resident ID

Wt Loss
≥5% in
≤30 Days

Wt Loss
≥10% in
≤180 Days

2 Meals
≤50% in 1 Day

Weekly Meal Intake Average
<50%

Daily Urinary Incontinence

>3 Days Bowel Incontinence

Foley Catheter

Current Pressure Ulcer

Triggers Last Week

Triggers This Week

Res1

0001

  

X

X

X

X

 

X

3

4

Res2

0002

X

  

X

X

X

 

2

4

Res3

0003

  

X

  

X

X

X

5

4

Res4

0004

 

X

  

X

X

X

 

0

4

Res5

0005

 

X

 

X

X

X

 

2

4

Res6

0006

  

X

X

X

 

0

3

Weight loss ≥5% in ≤30 days = Resident weight loss greater than or equal to 5% within the last 30 days from the date weight is recorded.

Weight loss ≥10% in ≤180 days = Resident weight loss greater than or equal to 10% within the last 180 days from the date weight is recorded.

2 Meals <50% in 1 day = Consumption of less than 50% for each of 2 meals in a single day.

Weekly meal intake average <50% = Average intake of breakfast, lunch, and dinner of less than 50% for the report week.

Daily urinary incontinence = Documented urinary incontinence daily for the report week.

>3 days bowel incontinence = Documented bowel incontinence at least once per day for at least 3 days during the report week.

Use of Foley catheter = Documented Foley catheter use.

Current pressure ulcer: Presence or absence of an ulcer. Does not display a count of all pressure ulcers. Information is taken from nursing documentation of wound assessments.

Dash = No data available.

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Current as of January 2011
Internet Citation: Table 4.1. Sample Pressure Ulcer Trigger Summary Report: Resident-Level Section: On-Time Quality Improvement Manual for Long-Term Care Facilities. January 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/ontimeqimanual/qimanltab4-1.html