AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention
This document provides an overview of the components of On-Time Pressure Ulcer Prevention, reports, and implementation materials used in preventing pressure ulcers in nursing homes. On-Time Pressure Ulcer Prevention has been developed over a 10-year period and piloted in more than 50 nursing homes. An outcome evaluation with New York nursing homes showed a 59 percent reduction in the incidence of pressure ulcers when at least three reports were integrated into care planning processes.i
We introduce the reports included in On-Time Pressure Ulcer Prevention and describe the purpose of each report, the content, and the likely users and uses of the reports. In general, reports help identify residents with increasing risk of pressure ulcer formation and help clinical staff easily understand the clinical picture of the resident and recent interventions to help make care plan decisions. These reports may also have other uses that help staff monitor residents' well-being. These have been included in likely users and uses.
A sample report is shown for each report, but the exact presentation of a report will depend on the electronic medical record (EMR) vendor that produces the report. The purpose of showing the sample reports is to give nursing home staff a sense of the type of information that is included in the reports. Exact specifications are provided to the vendor so that reports can be programmed correctly. Details of the reports are discussed as part of the training that is provided by an On-Time facilitator when a nursing home decides to implement this part of On-Time.
In 2014 some reports were updated slightly to account for changes in the Minimum Data Set (MDS) and to incorporate advances in existing EMRs. Two reports were added to help provide more information about treatment history and changing risks to improve the ability of clinicians to make clinical decisions and improve root cause analyses.
We also describe two worksheets that are provided to help staff integrate the reports into care planning. In addition, we include an "implementation steps" document that describes all the implementation steps that the change team needs to complete to fully implement the pressure ulcer prevention program. As with all On-Time topics, the reports and worksheets are designed to be used by a nursing home change team with the help of an On-Time facilitator who helps the team understand and use the reports and integrate the reports into day-to-day practice. A training curriculum for facilitators has been developed.
Table 1: On-Time Pressure Ulcer Prevention: Reports and Implementation Materials
|Reports and Worksheets Included
|Nutrition Risk Reports: High Risk and Medium Risk
|Weight Summary Report
|Trigger Summary Reports: Resident Level and Unit Level
|Risk Change Report
|Intervention History for Nutrition Risk Reports: High Risk and Medium Risk
|Resident Clinical, Functional, and Intervention Profile Report
|Self-Assessment Worksheet for Pressure Ulcer Prevention
|Pressure Ulcer Prevention Menu of Implementation Strategies
|Implementation Steps and Timeline
- Self-Assessment Worksheet for Pressure Ulcer Prevention.
- Pressure Ulcer Prevention Menu of Implementation Strategies.
- Implementation Steps and Timeline.
i. Olsho LE, Spector WD, Williams CS, et al. Evaluation of AHRQ's On-Time pressure ulcer prevention program: a facilitator-assisted clinical decision support intervention for nursing homes. Med Care 2014 Mar;52(3):258-66.