On-Time Quality Improvement Manual for Long-Term Care Facilities Table 4.3. Sample Trigger Summary Tracking Form Trigger Summary Report ReviewWeek 1Week 2Week 3Week 4Week 5Week 6Unit Information1# Residents on unit 2# Residents on unit with NEW pressure ulcers (all stages) 3# Residents on unit with existing pressure ulcers (all stages) Residents Who Trigger4# Residents with ≥4 triggers 5# Residents with ≥3 triggers 6# Resident with increase in triggers by ≥2 from previous week Residents Who Are Also7# High risk on Nutrition Report 8# Tube fed 13# Admitted within past 7 days 14# Admitted within past 30 days Interventions15# Referral: Dietitian 16# Referral: Wound nurse/team 17# Referral: Speech 18# Referral: Rehab 19# Referral: Psych Return to Document Current as of January 2011 Internet Citation: On-Time Quality Improvement Manual for Long-Term Care Facilities: Table 4.3. Sample Trigger Summary Tracking Form. January 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/ontimeqimanual/qimanltab4-3.html