AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention
Facilitator Training—Handouts: Overview of On-Time
- On-Time Reports
- Self-Assessment Worksheet
- Menu of Implementation Strategies
- Implementation Steps and Timeline
On-Time Reports
Sample Nutrition Report: High Risk
Sample Nutrition Report High Risk: Decreased meal intake and weight loss during report week Unit A |
||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Resident | Room Number | Decreased Intake: First Date | Avg Meal Intake % 3/1/14 | Avg. Meal Intake % 3/8/14 | Avg Meal Intake % 3/15/14 | Avg Meal Intake % 3/22/14 | Diet | TF | Avg. Supplement Intake % | Weight Change in lb) | Most Recent Ulcer Assess Date | # Pr Ulcers |
A | 001 | 03/23/2014 | 50 | 41 | 36 | 29 | Pureed 2/28/14 |
X | -1.5 | 3/20/14 | 2 | |
B | 002 | 03/26/2014 | 64 | 52 | 47 | 45 | Mech 1/22/14 |
50% | -3.3 | 3/20/14 | 1 | |
C | 003 | 03/29/2014 | 74 | 62 | 58 | 42 | Reg 3/22/14 |
-1.5 | ||||
D | 004 | 03/24/2014 | 86 | 89 | 71 | 59 | Reg 12/3/13 |
-2.5 |
Sample Trigger Summary Report—Resident Level
Name | Room | Wt Loss ≥5% in Prior 30 Days (Any) | Wt Loss ≥7.5% in Prior 90 Days (Point-to-Point) | Wt Loss ≥10% in Prior 180 Days (Point-to-Point) | 2 Meals ≤50% in 1 Day | Weekly Meal Intake Average <50% | Daily Urinary Incont | >3 Days Bowel Incont | Foley Catheter | Current Pressure Ulcer | # of Triggers Last Week | # of Triggers This Week |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Res1 | 330 | X | X | X | X | 3 | 4 | |||||
Res2 | 311 | X | - | X | X | X | 2 | 4 | ||||
Res3 | 321 | X | X | X | X | 5 | 4 | |||||
Res4 | 309 | X | X | X | X | 0 | 4 | |||||
Res5 | 312 | X | - | X | X | X | 2 | 4 | ||||
Res6 | 320 | X | - | - | X | X | 0 | 3 | ||||
Res7 | 342 | X | X | X | 3 | 3 | ||||||
Res8 | 337 | X | X | X | 2 | 3 | ||||||
Res9 | 301 | X | X | X | 1 | 3 | ||||||
Res10 | 316 | X | - | X | X | 2 | 3 | |||||
Total | 1 | 1 | 2 | 7 | 3 | 5 | 7 | 8 | 1 |
Sample Trigger Summary Report—Unit Level
Pressure Ulcer Triggers | Week 4 5/10/14 |
Week 3 5/17/14 |
Week 2 5/24/14 |
Week 1 5/31/14 |
---|---|---|---|---|
Wt Loss ≥ 5% in Prior 30 Days (ANY) | 1 (3%)(c) | 2 (6%)(a) | 1 (3%)(b) | 1 (3%)(c) |
Wt Loss ≥7.5% in Prior 90 Days (Point-to-Point) | 1 (3%)(c) | 1 (3%)(c) | 1 (3%)(c) | 1 (3%)(c) |
Wt Loss ≥10% in Prior 180 Days (Point-to-Point) | 1 (3%)(c) | 2 (6%)(a) | 1 (3%)(b) | 2 (3%)(a) |
2 Meals ≤50% in 1 Day | 5 (14%)(c) | 4 (11%)(b) | 4 (11%)(c) | 7 (20%)(a) |
Weekly Meal Intake Average <50% | 3 (9%)(c) | 3 (9%)(c) | 2 (6%)(b) | 3 (9%)(a) |
Daily Urine Incontinence | 2 (6%)(c) | 3 (9%)(a) | 3 (9%)(c) | 5 (14%)(a) |
>3 Days Bowel Incontinence | 5 (14%)(c) | 4 (11%)(b) | 3 (9%)(b) | 7 (20%)(a) |
Foley Catheter | 8 (23%)(c) | 7 (20%)(b) | 5 (14%)(b) | 8 (23%)(a) |
Current Pressure Ulcer | 0 (0%)(c) | 0 (0%)(c) | 0 (0%)(c) | 0 (0%)(c) |
Note: The report has been coded with (a) representing an increase, (b), a decrease, and (c), no change in weekly pressure ulcer trigger prevalence.
Sample On-Time Resident Clinical, Functional, and Intervention Profile Report
Week Ending | |||||
---|---|---|---|---|---|
4/6/14 | 4/13/14 | 4/20/14 | 4/27/14 | ||
Vital Signs | Number of pressure ulcers | 0 | 1 | 2 | 2 |
Temperature | 99.2 | ||||
Pulse | 82 | 88 | 90 | 100 | |
Respirations | 20 | 20 | 20 | 20 | |
Blood pressure | 102/58 | 110/60 | 102/58 | 120/88 | |
O2 saturation | 96 | 97 | 98 | 88 | |
Weight | Weight in pounds | 149.2 | 144 | ||
Weight date | 3/26/14 | 4/23/14 | |||
Nutrition / Vitamins & Supplements | Diet | Pureed | Pureed | Pureed | Clear liquids |
Tube feeding | No | No | No | No | |
Supplements | No | Ensure | Ensure | Ensure | |
Multivitamin | No | No | No | Yes | |
Vitamin C | No | Yes | Yes | Yes | |
Arginaid | No | No | No | No | |
Zinc | No | No | No | No | |
Protein | No | No | Yes | Yes | |
Weekly average meal intake—percent | |||||
Breakfast | 88 | 78 | 62 | 75 | |
Lunch | 79 | 74 | 25 | 25 | |
Dinner | 65 | 55 | 45 | 35 | |
Nutritional supplement—percent | |||||
Breakfast | 25 | 50 | 25 | 25 | |
Lunch | 25 | 25 | 25 | 25 | |
Dinner | 0 | 25 | 0 | 0 | |
Bowel | Habits | Continent | Continent | Incontinent | Incontinent |
Loose stool | No | No | Yes | Yes | |
Incontinence | |||||
# shifts / week | 0 | 0 | 12 | 18 | |
Daily incontinence | X | ||||
3 days without BM | X | X | |||
Bladder | Habits | Incontinent | Incontinent | Incontinent | Incontinent |
Catheter | Condom | No | No | Foley | |
Ostomy | No | No | No | No | |
Incontinence | |||||
# shifts / week | 9 | 12 | 12 | 14 | |
Daily incontinence | No | No | Yes | Yes | |
Did not void # shifts / week | 0 | 0 | 0 | 1 | |
Restorative | Bowel | No | No | No | No |
Bladder | No | No | Yes | Yes | |
Eating | No | No | No | No | |
Mobility | No | No | No | No | |
Self-Performance / Support Provided2 | Bed mobility | EA/1 | EA/1 | EA/1 | EA/2 |
Transfer | EA/1 | EA/1 | EA/1 | EA/2 | |
Locomotion | EA/1 | EA/1 | EA/1 | EA/2 | |
Dressing | LA/set up | EA/1 | EA/1 | EA/1 | |
Eating | LA/set up | EA/1 | EA/1 | EA/1 | |
Personal hygiene | LA/set up | EA/1 | EA/1 | EA/1 | |
Toileting | EA/1 | EA/1 | EA/1 | EA/2 | |
Labs1 | Pre-Albumin (19.5-35.8 mg/dL) | 33.0 | 21.6 | ||
Albumin (3.4-5.4 g/dL) | 3.4 | 3.6 | 5.8* | 6.2* | |
Sodium (135-145 mEq/L) | 128* | 122* | 114* | 120* | |
Potassium (3.5-5.2 mEq/L) | 4.0 | 4.3 | 4.4 | 4.3 | |
Creatinine (0.7-1.3 mg/dL) | 0.6* | 0.7 | 1.0 | 1.8* | |
BUN (6.0-20.0 mg/dL) | 6.0 | 6.2 | 6.0 | 6.1 | |
Transferrin (20-50%) | 20 | 25 | 35 | 35 | |
Bed Surfaces | Air fluidized surface | X | X | X | X |
Dynamic/alternating pressure | |||||
Low air loss | |||||
Replacement mattress | |||||
Chair Surfaces | Fluid filled or gel cushions | X | X | X | X |
Foam cushions | |||||
Combination cushions | |||||
Other | Heel boots | X | X | X | X |
1. Lab normal value ranges used by the facility in parentheses.* Indicates abnormal value.
2. These abbreviations are based on MDS 3.0 ADL coding: Self-Performance—EA= extensive assistance; LA = limited assistance; and Total = total dependent; the abbreviation after the slash represents ADL support provided—set up=set up help only, 1 or 2 = how many staff provide physical assistance.
Return to Contents
Proceed to Next Section
Return to Pressure Ulcer Prevention