On-Time Pressure Ulcer Healing: Introduction
On-Time Pressure Ulcer Healing was developed to provide nursing homes that have an electronic medical records (EMRs) system with tools to effectively monitor and manage pressure ulcers. Clinical reports provide resident and pressure ulcer information staff need to understand the number and types of pressure ulcers that have developed and are being treated at the facility and to make informed treatment decisions to promote timely healing.
The program uses the On-Time Pressure Ulcer Assessment to provide a set of structured, standardized data elements for comprehensive documentation of weekly pressure ulcer characteristics as well as treatments and interventions. The assessment tool guides clinicians to systematically assess residents with pressure ulcers and thus helps less-experienced clinicians assess and care for these residents. The tool also serves the most experienced clinicians in their pressure ulcer management practice.
Using data elements contained in the standardized assessment tool in combination with clinical data captured from nursing home EMR systems, staff generate reports that support earlier recognition of pressure ulcers at risk for delayed healing and infection. These reports also help improve clinical decisionmaking related to pressure ulcer treatment plans.
The clinical reports provide both high-level information that leadership may use to monitor residents with pressure ulcers being treated at the facility and more detailed reports that nurses can use to monitor resident status, including ulcer characteristics and healing progress. Reports display pressure ulcer assessment details, treatments, mobility status, bowel and bladder patterns, and other clinical details known to affect wound healing, such as nutrition, temperature, and ulcer pain.1
The clinical reports also display recognized measures for monitoring pressure ulcer healing status, such as surface area (computed from length and width dimensions), theBates-Jensen Wound Assessment Tool (BWAT)2 score, and a pressure ulcer risk assessment score from the Braden Scale3. These details, generated from multiple sources in the EMR, not only offer support for clinical decisionmaking and care planning but also reduce staff workload by eliminating manual information retrieval and compilation of data.
On-Time Pressure Ulcer Healing development began with a review of the literature and available clinical guidelines and included the input of a technical advisory panel of clinical and research experts. It also benefited from the input of a group of nursing home nurses who reviewed and provided input on report details and format.
On-Time Pressure Ulcer Healing includes five electronic reports and a menu of suggested implementation strategies for using each report to support clinical decisionmaking and promote effective collaboration and care coordination among disciplines. Implementation strategies include using reports separately or in various combinations to provide rich information to support team collaboration and care planning. For example, during wound rounds, the wound nurse may prefer having treatment details for each ulcer in trended format (Weekly Pressure Ulcer Treatment Summary Report) while the nurse manager may prefer having details about ulcers potentially experiencing delayed healing (Pressure Ulcers at Risk for Delayed Healing Report), and the entire team may attend wound rounds with a copy of the Weekly Wound Rounds Report in hand.
The On-Time Pressure Ulcer Healing reports assume the availability of a comprehensive pressure ulcer healing assessment. These electronic reports are intended for inclusion in the EMR system. Technical specifications are available for EMR vendor programmers to develop the reports as designed. Nursing homes will need to work with their vendor to determine the availability of data elements required for each report and to verify that staff are collecting accurate data to populate the needed data elements and collecting information needed for the reports. Each report is described in detail in the Electronic Reports section. If a nursing home uses a less comprehensive assessment, then the reports would need to be adjusted to account for the missing information.
Implementation materials include the Pressure Ulcer Healing Self-Assessment Worksheet, which guides staff in a review of current pressure ulcer healing practices. The self-assessment will help facilities planning to implement On-Time Pressure Ulcer Healing to identify areas with potential for improvement as they work toward On-Time implementation.
A menu of implementation strategies is another component of the On-Time program’s implementation materials. The implementation strategies menu offers a set of choices for reviewing report information in existing or new meetings or huddles and suggests attendees for these meetings. Providing a variety of strategies for using one report or a combination of reports allows the facility team to consider alternative uses that may fit within its current workflow and meet the unique needs of their facility, avoiding a “one-size-fits-all” approach. Table 1 lists reports and implementation materials for pressure ulcer healing.
Table 1: On-Time Pressure Ulcer Healing: Assessment, Reports, and Implementation Materials
|On-Time Pressure Ulcer Assessment|
|Reports Included in the Program|
|Existing Pressure Ulcers Report|
|Pressure Ulcers At Risk for Delayed Healing|
|Weekly Wound Rounds Report|
|Weekly Pressure Ulcer Treatment Summary Report|
|Pressure Ulcer Counts by Month Report|
|Self-Assessment Worksheet for Pressure Ulcer Healing|
|Menu of Implementation Strategies|
1 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014.
2 Available at: http://www.geronet.med.ucla.edu/centers/borun/modules/Pressure_ulcer_prevention/puBWAT.pdf (183 KB).
3 Available at: http://www.bradenscale.com/images/bradenscale.pdf (14.65 KB).