Implications for the Future

On-Time Prevention of Pressure Ulcers

Several insights were gained from these efforts and will be used to answer the following questions as we design future implementations:

  • What is the best way to partner effectively with nursing home organizations with multiple facilities?

    An On-Time implementation strategy involves both top leadership and front-line clinical teams throughout the entire implementation time period. This will be a factor specifically in nursing home organizations with multiple facilities. While the initial focus of implementation is with front-line teams, ongoing discussions will involve top leadership and identify how they can support the front-line processes. For example, as QI initiatives or new processes are rolled out, it is important that the work of the front-line teams be taken into account. Also, as clinical consultants such as dietary staff work with front-line teams, if they fully understand the reports available from the project, they will be able to integrate the reports into their work as well.

  • How can we strengthen training for the entire multidisciplinary team in use of decisionmaking reports to identify residents at risk and coordinate care with the multidisciplinary team? For example, one barrier often encountered was that Minimum Data Set (MDS) nurses preferred using paper forms to review documentation instead of reports. They wanted to see actual documentation—the entire form. Another was that in general nurses resisted reviewing weekly On-Time reports.
  • How do we expand into other clinical areas the initial success of the On-Time approach to reduce pressure ulcers (PrUs)? Several facilities have started using the On-Time approach in an effort to improve wound assessment documentation and PrU treatment. Other clinical areas that are being considered include fall management and incontinence.
Page last reviewed March 2009
Internet Citation: Implications for the Future: On-Time Prevention of Pressure Ulcers. March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/pressure-ulcers/pressureulcers/puqio7.html