Sample Reports

On-Time Quality Improvement for Long-Term Care

The On-Time program is funded by the Agency for Healthcare Research and Quality (AHRQ), with support from the California Healthcare Foundation, to improve long-term care by turning daily documentation into useful information that enhances clinical care planning. These are samples of clinical reports used by front-line teams on a weekly basis to monitor resident status and prompt for changes in the care plan.

Completeness Report / Nutrition Report / Behavior Report / Pressure Ulcer Trigger Summary Report / Priority Reports 

Completeness Report

I. Documentation Completeness: All Shifts

Documentation Item7/10/20067/17/20067/24/20067/31/2006
Meal Intake90.284.983.788.3
Bowels65.861.963.372.7
Bladder60.163.160.470.3
Behaviors72.074.876.581.7

II. Summary for Week of 7/31

Total Residents30
# residents missing ≥75% nutritional intake data 0
# residents missing ≥75% of bowel data 0
# residents missing ≥75% of bladder data 0
# residents missing ≥75% of behavior data 0

III. Documentation Completeness: Night Shift

Documentation Item7/10/20067/17/20067/24/20067/31/2006
Bowels39.741.645.262.9
Bladder40.658.046.568.1
Behaviors46.069.065.077.6

IV. Documentation Completeness: Day Shift

Documentation Item7/10/20067/17/20067/24/20067/31/2006
Breakfast88.884.182.085.2
Lunch92.086.982.985.2
Bowels87.576.373.375.7
Bladder68.362.961.367.1
Behaviors87.983.382.981.0

V. Documentation Completeness: Evening Shift

Documentation Item7/10/20067/17/20067/24/20067/31/2006
Dinner89.783.786.294.3
Bowels70.167.871.479.5
Bladder71.468.673.375.7
Behaviors82.172.281.686.7

VI. Form Consistency Errors

NameResident IDSectionDescription
Sample Resident 1000111908/01 (E) bladderCatheter but Incontinent Urine Count not 0
Sample Resident 2003890008/02 (E) bladderCatheter but Incontinent Urine Count not 0
Sample Resident 3008280008/02 (N) bladderCatheter but Incontinent Urine Count not 0
Sample Resident 4000111708/03 (E) behaviorsNo Behaviors Observed and Frequent Crying both checked
Sample Resident 45004710008/03 (E) behaviorsNo Behaviors Observed and Abusive Language both checked

VII. Resident Summary Details: Sample

NameResident IDSection% Complete
______________________XBehaviors85.7
______________________XBladder71.4
______________________XBowels66.7
______________________XMeals95.2
______________________XBehaviors76.2
______________________XBladder71.4
 XBowels76.2
 XMeals90.5
______________________Xbehaviors85.7
______________________XBladder71.4
______________________XBowels81.0
______________________XBehaviors71.4
______________________XBladder66.7

Top of Page

 

Nutrition Report

High Risk (Decreased Meal Intake and Weight Loss)

Resident NameResident
ID
Decreased
Intake
Avg Meal
Intake %
Wk.
07/10/06
Avg Meal
Intake %
Wk.
07/17/06
Avg Meal
Intake Wk.
% 07/24/06
Avg Meal
Intake %
Wk.
07/31/06
Wt.
Change
lbs.
History
Resolved PU
Most
Recent
Ulcer
Assess
Date
# PUs
Sample Resident 100011197/31/200673516152-2.3 --
Sample Resident 200389007/31/2006073336-6.2 7/19/20061

Medium Risk (Decreased Meal Intake or Weight Loss)

Resident
Name
Resident
ID
Decreased
Intake
Avg Meal
Intake %
Wk.
07/10/06
Avg Meal
Intake %
Wk.
07/17/06
Avg Meal
Intake Wk.
% 07/24/06
Avg Meal
Intake %
Wk.
07/31/06
Wt.
Change
lbs.
History
Resolved PU
Most
Recent
Ulcer
Assess
Date
# PUs
Sample Resident 1000000007/31/200632344042- --
Sample Resident 2111111107/31/20067676-71- --
Sample Resident 3000111908/02/200649364454- --
Sample Resident 4003890008/01/20067478-64- --
Sample Resident 5008280007/31/200656234343- --
Sample Resident 6000111707/31/200641232847- --
Sample Resident 7004710008/04/200673717162- --

Weight Summary

Resident
Name
Resident
ID
Wt. 180
Days Prior
Wt. 90
Days Prior
Wt. For Wk.
07/10/06
Wt For Wk.
07/17/06
Wt. For Wk.
07/24/06
Wt. For Wk.
07/31/06
Wt.
Change lbs.
Date 5-10% Wt.
Loss ≤ 30 Days
Date
> 10% Wt. Loss
≤ 180 Days
Sample Resident 10000000--139-1391401--
Sample Resident 21111111---------
Sample Resident 30001119--159159--0--
Sample Resident 40038900---------

Top of Page

 

Behavior Report

Number of Residents with Behaviors by Shift: Unit Snapshot

ShiftFrequent
Crying
Yell/
Scream
Kicking/
Hitting
Pinch/
Scratch/
Spit
BitingWanderingAbusive
Language
Threatening
Behavior
Resists
Care
Repititive
Verbalization
Repititive
Movement
Sexually
Inappropriate
Behavior
D2 (6%)4
(13%)
1 ( 3%)0 ( 0%)0
(0%)
4 (13%)2 ( 6%)2 ( 6%)2
( 6%)
4
(13%)
2 (6%)0 (0%)
E1 (3%)4
(13%)
1 ( 3%)0 ( 0%)0
(0%)
4 (13%)2 ( 6%)1 ( 3%)5
( 17%)
5
( 17%)
1 (3%)0 (0%)
N3 (10%)3
(10%)
0 ( 0%)0 ( 0%)0
(0%)
0 ( 0%)1 ( 3%)0 ( 0%)3
( 10%)
3
( 10%)
2 (6%)0 (0%)
All5 (17%)5
(17%)
1 ( 3%)0 ( 0%)0
(0%)
5 ( 17%)2 ( 6%)2 ( 6%)6
( 20%)
5
( 17%)
3 (10%)0 (0%)


NameResident
ID
ShiftFrequent
Crying
Yell/
Scream
Kicking/
Hitting
Pinch/
Scratch/
Spit
BitingWanderingAbusive
Language
Threatening
Behavior
Resists
Care
Repititive
Verbalization
Repititive
Movement
Sexually
Inappropriate
Behavior
Total
# of
Behaviors
 XD0000000001102
  E0000000003306
  N0000000000000
 XD0100000011003
  E1000000033007
  N3100000031109
 XD06000050000011
  E0500004000009
  N07000060000013
 XD0110020111007
  E01100402120011
  N0000000000000

Top of Page

 

Pressure Ulcer Trigger Summary Report

Number of Residents and the Percentage of the Unit Within Each Trigger by Week

Pressure Ulcer TriggersWeek 1Week 2Week 3Week 4
 2006-07-102006-07-172006-07-242006-07-31
Wt. Loss 5-10% in ≤ 30 Days----
Wt. Loss > 10% in ≤ 180 Days----
2 Meals ≤ 50% in 1 Day 6 (18%) 8 (23%) 8 (23%) 8 (22%)
Weekly Meal Intake Average < 50% 4 (12%) 7 (20%) 5 (14%) 4 (11%)
Daily Urine Incontinence10 (30%)16 (47%)13 (38%)15 (41%)
> 3 Days Bowel Incontinence.13 (39%)18 (52%)12 (35%)15 (41%)
Catherized10 (30%)16 (47%)8 (23%)12 (33%)
History of Resolved Ulcer----
Current Pressure Ulcer----

Pressure Ulcer Trigger Summary by Resident for Current Week

NameResident
ID
Wt. Loss 5-10% in
≤ 30 Days
Wt. Loss
> 10% in
≤ 180 Days
2 Meals < 50% in 1 DayWeekly Meal Intake Average < 50%Daily Urine
Incontinence.
> 3 Days Bowel IncontinenceCatheterHistory of
Resolved
Ulcer
Current
Pressure
Ulcer
# of Triggers
Last Week
# of
Triggers
This Week
 X  XXXX   34
 X    XXX  23
 X  X  XX  53
 X    XXX  03
 X    XXX  23
 X  X  XX  03
 X  XX  X  33
 X    XX   12
 X  X   X  12
 X     XX  32

Top of Page

 

Priority Reports

Priority Report

NameResident
ID
Decreased
Meal +
Wt. Loss
Wt. Loss
≥5% Last
30 Days
Incontinence
Increase
Different
Behaviors
≥ 31
Worsening
Ulcer
New
Ulcer
Open
Area
Resident Name0001122   3*   
Resident Name0079601  X   X
Resident Name0052124  X4*   
Resident Name0001637  X    
Resident Name0003242  X4   
Resident Name0039624  X X  
Resident Name0065677      X
Resident Name0002146  X XXX

1 Definition
Behaviors ≥ 3: If 2 or more different behaviors present for the report week that did not present during previous week
AND total number of behaviors ≥ 3, display total number of behaviors with asterisk next to number (asterisk indicates 2
or more additional, different behaviors from previous report week).
Examples
If < 3 different behaviors THEN leave behaviors column blank
If ≥ 3 different behaviors for current week THEN display total # behaviors
If ≥ 3 different behaviors for current week AND increase in total # of different behaviors from previous week by
≥ 2 THEN display # behaviors for current week and asterisk next to number

Residents with Red Areas

NameResident IdRed Area
Resident Name0001119X
Resident Name0038900X
Resident Name0082800X
Resident Name0001117X
Resident Name0047100X
Page last reviewed November 2008
Internet Citation: Sample Reports: On-Time Quality Improvement for Long-Term Care. November 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/qualityimprov/pusamplerep.html