AHRQ's Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention
Facilitator Training Instructor Guide Slide Presentation
Slide 1: Introduction to Pressure Ulcer Prevention Reports
AHRQ's Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention
Introduction to Pressure Ulcer Prevention Reports
Slide 2: Pressure Ulcer Prevention Electronic Reports
- Electronic Reports:
- Nutrition Risk Reports: High and Medium Risk.
- Weight Summary Report.
- Trigger Summary Reports: Resident and Unit Level.
- Risk Change Report.
- Intervention History for Nutrition Risk Reports: High and Medium Risk.
- Resident Clinical, Functional, and Intervention Profile Report.
- Completeness Report (Optional).
Slide 3: Teaching the Pressure Ulcer Prevention Electronic Reports
- The teaching sessions for each report should include the following content:
- Purpose of the report.
- Content of the report.
- Calculation details.
- Quizzes and exercises.
Slide 4: Nutrition risk reports
Nutrition Risk Reports
Slide 5: Nutrition Reports: High Risk and Medium Risk
- Provides the clinician with an overall portrait of resident nutrition risk status.
- Displays the following:
- First date that decreased meal intake was noted.
- Average weekly meal intake for 4 weeks.
- Diet order and tube feeding status.
- Average supplement intake for report week.
- Any recent weight change.
- Most recent ulcer assessment date.
- # pressure ulcers.
Slide 6: Nutrition Reports: High Risk and Medium Risk Criteria
- Sorts residents into high and medium risk using two criteria to determine level of nutritional risk:
- Criterion 1: If meal consumption is 50% or less for two meals in one day at least one time during the report week.
- Criterion 2: If there is any weight loss during the report week, determined by subtracting the current week's weight from the most recent weight.
- Residents meeting either one of the criteria are categorized as medium risk; residents meeting both criteria are considered high risk.
Slide 7: 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 | 03/28/2014 | 74 | 62 | 58 | 42 | Reg 3/22/14 | -1.5 | ||||
D | 004 | 03/24/2014 | 86 | 89 | 71 | 59 | Reg 12/3/13 | -10.5 |
Slide 8: Reviewing Nutrition Report Calculation Details
- Decreased Intake: First Date.
- Average Weekly Meal Intake.
- Diet Order/Date.
- Tube Feeding.
- Average Supplement Intake Percentage.
- Weight Change.
- Most Recent Ulcer Assessment Date.
- # Pressure Ulcers.
Slide 9: Check Your Understanding: Nutrition Report Quiz
- A resident must have lost a minimum of 1 pound in order to display either on the High-Risk Nutrition Report or the Medium-Risk Nutrition Report.
- True
- False
- Residents who have not been weighed during the report week cannot display on the High-Risk Nutrition Report.
- True
- False
Slide 10: Check Your Understanding: Nutrition Report Quiz
- Residents who display on the High Risk Nutrition Report (select all that apply):
- Must have met at least one of two high-risk criteria for nutritional risk.
- Must have lost weight during the report week.
- Must have consumed an average weekly meal intake of ≤50% for the report week.
- Must have consumed ≤50% for at least one meal during the report week.
- Must have consumed ≤50% for two meals in a single day during the report week.
- None of the above.
- All of the above.
Slide 11: Check Your Understanding: Nutrition Report Quiz
- How can a person be tube fed and also have any meal intake?
- Not possible.
- Only when meal intake includes consuming pleasure foods.
- Tube feeding intake is counted as a meal intake.
Slide 12: Nutrition Report Exercise
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 | 9/27/13 | 60 | 71 | 76 | 69 | Pureed 8/10/13 | X | ‐0.2 | |||
B | 002 | 9/28/13 | 94 | 92 | 97 | 85 | Reg 9/10/12 | ‐60.6 | ||||
C | 003 | 9/27/13 | 49 | 52 | 37 | 32 | Pureed 7/10/13 | 50% | ‐1.6 | |||
D | 004 | 9/29/13 | 33 | 75 | 31 | 92 | Reg 6/30/13 | ‐0.2 | ||||
E | 005 | 9/30/13 | 10 | 11 | 0 | 0 | Pureed | 25% | ‐212.2 | |||
F | 006 | 9/29/13 | 0 | 0 | 0 | 0 | NPO 9/1/13 | X | ‐2.2 | |||
G | 007 | 9/28/13 | 96 | 88 | 85 | 92 | Reg 7/1/13 | ‐10.5 | ||||
H | 008 | 9/29/13 | 0 | 0 | 0 | 0 | NPO 9/15/13 | X | ‐0.8 | |||
I | 009 | 9/27/13 | 85 | 92 | 38 | 85 | Mech 8/15/13 | +1.2 | ||||
J | 010 | 9/30/13 | 26 | 30 | 40 | 25 | Pureed 5/14/13 | 75% | ‐1.8 | |||
K | 011 | 9/29/13 | 0 | 0 | 0 | 0 | NPO 9/20/13 | ‐1.0 | ||||
L | 012 | 9/27/13 | 98 | 95 | 92 | 88 | Reg 6/15/13 | ‐6.1 |
Slide 13: Weight summary report
Weight Summary Report
Slide 14: Weight Summary Report
- The Weight Summary Report:
- Displays 4 weeks of trended weights for each resident.
- Calculates weight changes.
- Displays significant weight loss in prior 7, 30, 90, and 180 days.
- Weights are calculated in two ways:
- Point-to-Point: Using two data points, to determine if weight loss occurred.
- Any Weight Loss: Using multiple weight comparisons within a specified period to identify "Any" weight loss within the period.
Slide 15: Sample Weight Summary Report
Name | ID | Weight 180 Days Prior | Weight 90 Days Prior | Weight 30 Days Prior | Weight for Week 5/3/14 Week4 | Weight for Week 5/10/14 Week3 | Weight for Week 5/17/14 Week2 | Weight for Week 5/24/14 Week1 | Weight Change lb | ≥2% Wt Loss (from previous week) | ≥5 lb Wt Loss in Prior 30 Days | ≥5% Wt Loss in Prior 30 Days | ≥5% Wt Loss in Prior 30 Days (Any) | ≥7.5% Wt Loss in Prior 90 Days | ≥10% Wt Loss in Prior 180 Days |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
A | ###1 | 285.3 | 275.0 | 254.5 | 252.4 | 256.1 | 251.7 | 253.8 | 2.1, 5/24/14 | 7.7% | 11.0% | ||||
B | ###2 | 172.1 | 175.3 | 180.0 | 180.0 | 170.0 | 181.0 | 171.0 | -10.0, 5/24/14 | 5.5% | 9.0 | 5.6% | 5.6%, 5/10/14; 5.0%, 5/24/14 5.5%, 5/24/14 |
Slide 16: Reviewing Calculation Details for Weight Summary Report
- Weight in Prior 180 Days.
- Weight in Prior 90 Days.
- Weight in Prior 30 Days.
- Weight for Weeks 1-4.
- Weight Change.
- ≥2 Percent Weight Loss (from previous week).
- ≥5 Lb Weight Loss in Prior 30 Days.
- ≥5 Percent Weight Loss in Prior 30 Days (Point-to-Point).
- ≥5 Percent Weight Loss in Prior 30 Days (Any).
- ≥7.5 Percent Weight Loss in Prior 30 Days (Point-to-Point).
- ≥10 Percent Weight Loss in Prior 180 Days (Point-to-Point).
Slide 17: Check Your Understanding: Weight Summary Report Quiz
- If multiple weights are taken during the report week, the highest weight is used for report calculations.
- True
- False
- When determining Weight in Prior 30 Days, first identify all weights documented in the past 28-32 days.
- True
- False
Slide 18: Check Your Understanding: Weight Summary Report Quiz
- If a resident was not weighed weekly, what weight values would you expect to see on the report?
- Four consecutive monthly weights instead of weekly weights.
- Weight values in weeks when weights were recorded and blank cells when weights were not recorded.
- The resident would not display on the report if weekly weight values were not recorded.
- None of the above.
Slide 19: Check Your Understanding: Weight Summary Report Quiz
- How is Weight in Prior 180 Days determined? (Select all that apply)
- Identify all weights that occur in the range of 170 to 190 days from the most recent weight date, select the weight closest to 180 days.
- Identify all weights that occur in the range of 175 to 180 days from the most recent weight date, select the weight closest to 180 days.
- If two weights are the same distance from 180 days, select the highest weight.
- If two weights are the same distance from 180 days, select the lowest weight.
- None of the above.
Slide 20: Trigger summary reports
Trigger Summary Reports
Slide 21: Trigger Summary Reports: Resident Level and Unit Level
- Identifies residents at risk for pressure ulcer development due to an increase in pressure ulcer risk factors or triggers from the prior week.
- Available at the resident and unit level, it reports on nine triggers associated with pressure ulcer development
- Weight loss ≥5 percent in prior 30 days.
- Weight loss ≥7.5 percent in prior 90 days.
- Weight loss ≥10 percent in prior 180 days.
- 2 meals with intake ≤50 percent in one day.
- Weekly meal intake averaging <50 percent.
- Daily urinary incontinence.
- More than 3 days of bowel incontinence.
- Presence of a Foley catheter.
- Current pressure ulcer.
- Also shows # triggers last week and # triggers this week.
Slide 22: 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 |
Slide 23: Reviewing Calculation Details for the Trigger Summary Report: Resident Level
- Wt Loss ≥5% in Prior 30 Days (Any).
- Wt Loss ≥7.5% in Prior 90 Days.
- Wt Loss ≥10% in Prior 180 Days.
- 2 Meals ≤50% in 1 Day.
- Weekly Meal Intake Average <50%
- Daily Urinary Incontinence.
- >3 Days of Bowel Incontinence.
- Use of Foley Catheter.
- Current Pressure Ulcer.
- # Triggers Last Week.
- # Triggers This Week.
Slide 24: Trigger Summary Report: Unit Level
- Displays the number of residents (and percentage of total nursing unit census) who meet each of the trigger criteria.
- Displays 4 weeks of information.
- Is used to monitor the overall prevalence and trends in pressure ulcer triggers on a specific nursing unit.
- May be useful for program monitoring and planning or identifying in-service needs of staff.
Slide 25: 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 | 1 (3%) (c) | 1 (3%) (c) | 1 (3%) (c) | 1 (3%) (c) |
Wt Loss ≥ 10% in prior 180 Days | 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 color coded with red (a) representing an increase, green (b), a decrease, and white (c), no change in weekly pressure ulcer trigger prevalence.
Slide 26: Reviewing Calculation Details for the Trigger Summary Report: Unit Level
- Displays column values for each week, including:
- Number: The number of residents on the nursing unit with the specified trigger for each of the 4 weeks displayed.
- Percentage: The number of residents with the specified trigger for the week displayed as a percentage of the total number of residents on the nursing unit.
- Dash: The value shown when no data are available.
Slide 27: Check Your Understanding: Trigger Summary Report Quiz
- Trigger Summary Report is based on nine triggers associated with pressure ulcer development.
- True
- False
- Residents must meet at least two triggers during the report week to display on the report.
- True
- False
Slide 28: Check Your Understanding: Trigger Summary Report Quiz
- There are three views of the Trigger Summary Report- Resident Level, Unit Level, and by Specific Trigger.
- True
- False
Slide 29: Check Your Understanding: Trigger Summary Report Quiz
- If a resident has incomplete bladder or urinary incontinence documentation during the report week, on the Trigger Summary Report:
- The daily urinary incontinence column will be blank.
- The daily urinary incontinence column will show a dash (-).
- A resident having incomplete documentation for any one trigger used for the report cannot display on the report.
- None of the above.
Slide 30: Check Your Understanding: Trigger Summary Report Exercise
Using the Sample Trigger Summary Report below, select the four residents that you would consider highest priority.
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 | A | X | X | X | X | X | X | 3 | 6 | |||
Res2 | B | X | X | X | X | X | 5 | 5 | ||||
Res3 | C | X | X | X | X | X | 2 | 5 | ||||
Res4 | D | X | X | X | X | 3 | 4 | |||||
Res5 | E | X | - | - | X | X | X | 1 | 4 | |||
Res6 | F | X | X | X | X | 0 | 4 | |||||
Res7 | G | X | X | X | X | 2 | 4 | |||||
Total | 3 | 1 | 4 | 3 | 4 | 5 | 6 | 6 | 1 |
Slide 31: Risk change report
Risk Change Report
Slide 32: Risk Change Report: Resident Changes and Declines From Prior Week
- Intended to provide a priority list of residents with week-to-week changes in factors associated with pressure ulcer risk, nutrition, and weight loss.
- Alerts the nurse to new or worsening pressure ulcer.
- Uses six criteria to alert for potential risk for pressure ulcer development:
- Nutrition risk, including decline in meal intake and weight loss.
- Increase in bladder and/or bowel incontinence.
- Decline in three ADLs (bed mobility, transfer, and toileting).
- Pressure ulcer status (new or worsening ulcer).
- Three or more different behaviors.
- Acute change in health status.
Slide 33: Sample Risk Change Report
Name | Room Number | Nutrition Risk | Change Within 7 Days | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Increase in Incontinence | ADL Decline# | ≥3 Behaviors | Pressure Ulcer | Health Status# | |||||||||
Decreased Meal Intake + Weight Loss | Decreased Meal Intake | Weight Loss ≥5% in Prior 30 Days | Urine | Bowel# | Bed Mobility | Transfer | Toileting | Change in Behavior Types From Prior Week(*) | Worsening Ulcer | New Ulcer | Acute Change in Status | ||
Resident 1 | 202 | X | 7* | ||||||||||
Resident 2 | 212 | X | X | X | X | X | |||||||
Resident 3 | 217 | X | X | X | 3 | ||||||||
Resident 4 | 229 | X | X | ||||||||||
Resident 5 | 231 | X | X | X | |||||||||
Resident 6 | 242 | X | |||||||||||
Resident 7 | 243 | 4 | X |
Note: If three or more behaviors for a resident were documented during the current week then the number of behaviors will display.
* An asterisk will display next to the number of behaviors if the behaviors recorded during the current report week are different from behaviors recorded during the prior week.
# indicates column added in 2014.
Slide 34: Reviewing Calculation Details for the Risk Change Report
- Decreased Meal Intake AND Weight Loss.
- Weight Loss ≥5% in Prior 30 Days (Any).
- Urinary Incontinence Increase.
- Bowel Incontinence Increase.
- ADL Decline.
- ≥3 Behaviors.
- Worsening or New Pressure Ulcer.
- Acute Change in Status.
Slide 35: Check Your Understanding: Risk Change Report Quiz
- The Priority Report displays residents who have changes in documentation of urinary incontinence and behaviors from the prior report week.
- True
- False
- An asterisk (*) displays next to the number of behaviors when:
- The resident is a new admission.
- The resident has not had behaviors documented previously.
- The behaviors required medication intervention.
- Two or more behaviors for the report week were different from behaviors documented the prior week.
- None of the above.
Slide 36: Check Your Understanding: Risk Change Report Quiz
- What would you expect to see on the Risk Change Report for a resident who triggered for High-Risk Nutrition but has incomplete bladder and behavior. documentation for the report week?
- An X will display in "Decreased Meal Intake + Wt Loss".
- A dash (-) will display in "Urinary Incontinence Increase" and "Behaviors ≥ 3".
- The values for "Urinary Incontinence Increase" and "Behaviors ≥3" will be blank.
- The resident will not display on the Risk Change Report when any report documentation is incomplete.
- None of the above
Slide 37: Intervention history for nutrition risk reports
Intervention History for Nutrition Risk Reports
Slide 38: Intervention History for Nutrition Risk Reports
- Displays residents at nutritional risk, plus additional information on referrals, physician visits, and laboratory tests.
- For each resident at high or medium nutritional risk, the report captures the following information from EMR physicians' orders:
- Resident nutrition information such as current diet, date of diet order, and supplement order date.
- Referrals and referral dates for physical therapy, occupational therapy, speech therapy, social services, psych, gastroenterology, and hospice services.
- Date the resident was last seen by the attending physician, nurse practitioner, or physician assistant.
- Last order dates for chemistry, microbiology, and hematology.
Slide 39: Sample Intervention History for Nutrition Risk Report: High Risk
High-Risk Residents | Room | Diet | Diet Changes | Supplements | PT | OT | Speech | Social Services | Psych | Gastroenterology | Hospice | Seen by MD/PA or NP | Chemistry | Microbiology | Hematology | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Brown, M | 201 | Regular | 1/3/14 | 10/4/13 | 1/2/14 | 1/2/14 | 1/2/14 | 11/27/13 | 7/3/13 | 7/3/13 | |||||
2 | White, D | 209 | Regular | 10/20/13 | 9/2/13 | 10/18/13 | 11/2/13 | 12/27/13 | 11/13/13 | 11/13/13 | 11/13/13 | 11/13/13 | 11/13/13 | |||
3 | Green, D | 212 | Pureed | 12/23/13 | 12/30/13 | 1/2/14 | 1/2/14 | 12/18/13 | 12/18/13 | |||||||
4 | Orange, L | 221 | NPO | 1/5/14 | 12/15/13 | 1/3/14 | 1/3/14 | 6/2/13 | 6/2/13 | |||||||
5 | Pink, S | 222 | Diabetic | 7/22/13 | 12/31/13 | 7/25/13 | 2/18/13 | 2/18/13 | ||||||||
6 | Silver, C | 237 | Low NA | 12/18/13 | 11/29/13 | 5/12/13 | 5/12/13 | 5/12/13 | ||||||||
7 | Reddish, R | 238 | Regular | 9/6/13 | 12/4/13 | 9/6/13 | 12/4/13 | 12/4/13 | ||||||||
8 | Black, B | 240 | Pureed | 10/3/13 | 1/2/14 | 2/18/13 | 12/4/13 | 12/4/13 |
Note: Separate reports for high and medium nutritional risk residents can be produced.
Slide 40: Reviewing Details for Intervention History for Nutrition Risk Reports
- All information is derived from MD/NP/PA orders.
- If there are multiple orders for a single item, the most recent order date will display.
- If the EMR can interface with lab information system, an asterisk (*) next to laboratory tests will indicate an abnormal result.
Slide 41: Check Your Understanding: Intervention History for Nutrition Risk Reports Quiz
- The Intervention History for Nutrition Risk Report is derived from:
- Dietary notes.
- Nursing assistant documentation.
- Therapy records.
- Physician/NP/PA orders.
- None of the above.
Slide 42: Check Your Understanding: Intervention History for Nutrition Risk Reports Quiz
- When could the Intervention History for Nutrition Risk Report be used to support decisionmaking?
- Nutrition-at-risk meetings.
- Nursing assistant huddle with dietitian.
- MDS assessment.
- Root Cause Analysis for new pressure ulcer development.
- All of the above.
Slide 43: Check Your Understanding: Intervention History for Nutrition Risk Reports Quiz
- Residents who display on the Intervention History for Nutrition High-Risk Report are the same residents who display on the Nutrition High-Risk Report.
- True.
- False.
- Residents who display on the Intervention History for Nutrition Medium-Risk Report are the same residents who display on the Nutrition Medium-Risk Report.
- True.
- False.
Slide 44: Resident clinical, functional, and intervention profile report
Resident Clinical, Functional, and Intervention Profile Report
Slide 45: Resident Clinical, Functional, and Intervention Profile Report
- Displays 4 weeks of clinical data for a single resident that is captured from electronic nursing assistant daily charting, physician orders, and lab result values.
- Information from nursing assistant documentation includes:
- Resident weight.
- Vital signs.
- Weekly average meal intake percentages for breakfast, lunch, and dinner.
- Bowel and bladder documentation.
- Activities of daily living.
- Information from physician orders includes:
- Pressure ulcer prevention devices (e.g., bed and chair surfaces).
- Nutrition orders (e.g., diet order, tube feeding, and supplements).
- Data are reported for 4 consecutive weeks for a single resident.
Slide 46-48: Sample 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.
Slide 49: Reviewing Details for Resident Clinical, Functional, and Intervention Profile Report
- All information is derived from nursing assistant documentation, vital signs, lab results, physician orders, and other documentation in the EMR.
- Report information is captured as a result of daily charting; no additional charting is required.
Slide 50: Check Your Understanding: Resident Clinical, Functional, and Intervention Profile Report Quiz
- The report data show weekly or monthly trends or you can choose which weeks to display when generating the report.
- True
- False
- The report displays information at the unit level as well as the resident level.
- True
- False
Slide 51: Check Your Understanding: Resident Clinical, Functional, and Intervention Profile Report Quiz
- This report shows trended data on (select all that apply):
- ADLs.
- Activities participation.
- Weight.
- Vital signs.
- Diet.
- Percent supplement intake.
- Rehab therapy.
Slide 52: Completeness report
Completeness Report
Slide 53: Completeness Report (Optional)
- Verifies that nursing assistant documentation is complete enough to run report calculations
- On-Time reports will not generate unless at least 75% of documentation is available.
- Most EMR systems provide another mechanism to monitor completion of nursing assistant documentation.
- Available at the facility, unit, or shift level to check meal intake, bowels, bladder, and behaviors.
Slide 54: Sample Completeness Report: Facility Level
Documentation Section | 5/29/13 | 6/5/13 | 6/12/13 | 6/19/13 |
---|---|---|---|---|
Meal Intake | 92.2 | 93.1 | 90.4 | 92.0 |
Bowels | 67.6 | 74.9 | 66.2 | 58.3 |
Bladder | 54.8 | 61.7 | 78.2 | 86.9 |
Behaviors | 53.1 | 69.9 | 87.1 | 91.0 |
Slide 55: Sample Completeness Report By Shift
Day Shift
Documentation Section | 5/29/13 | 6/5/13 | 6/12/13 | 6/19/13 |
---|---|---|---|---|
Meal Intake Breakfast | 88.2 | 97.2 | 99.1 | 99.4 |
Meal Intake Lunch | 98.4 | 96.2 | 92.2 | 96.6 |
Bowels | 87.6 | 84.9 | 96.2 | 98.3 |
Bladder | 54.8 | 61.7 | 78.2 | 86.9 |
Slide 56: Sample Completeness Report By Shift
Evening Shift
Documentation Section | 5/29/13 | 6/5/13 | 6/12/13 | 6/19/13 |
---|---|---|---|---|
Meal Intake Dinner | 90.0 | 92.0 | 80.0 | 80.0 |
Bowels | 97.6 | 94.9 | 96.2 | 98.3 |
Bladder | 54.8 | 61.7 | 78.2 | 86.9 |
Behaviors | 53.1 | 69.9 | 87.1 | 91.0 |
Slide 57: Sample Completeness Report By Shift
Night Shift
Documentation Section | 5/29/13 | 6/5/13 | 6/12/13 | 6/19/13 |
---|---|---|---|---|
Bowels | 67.6 | 64.9 | 66.2 | 58.3 |
Bladder | 54.8 | 61.7 | 78.2 | 86.9 |
Behaviors | 53.1 | 69.9 | 87.1 | 91.0 |
Slide 58: Reviewing Calculation Details for Completeness Report
- Percentage calculation is the same for each documentation section.
- For each section:
- Determine the total number of possible charting entries.
- Count the number of shifts for which documentation is available.
- Divide the number of actual documentation entries by the total number of possible entries for all residents for the current week.
Slide 59: Check Your Understanding: Completeness Report Quiz
- Review the sample Completeness Report by facility:
- Which documentation category has the highest completion rate? The lowest completion rate?
- Which category has shown no improvement over the 4 weeks? The most fluctuation from week to week?
- What questions would you ask the team about their changes in bladder completeness?
Slide 60: Check Your Understanding: Completeness Report Quiz
- Review the sample Completeness Reports by shift:
- What can you say about documentation in the most current week?
- What trends are worth noting?
- Which shift has the most consistent rate?
- Which shift has the most fluctuation in rates?
- What areas of documentation need some followup investigation?