AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention

Pressure Ulcer Prevention Handouts (continued)

Implementation of the Prevention Reports Into Day-to-Day Practice

Review of the Change Team's Process of Choosing On-Time Reports, Incorporating Them Into Huddles and Meetings, and Piloting Those Meetings: Unscripted Exercise #2

Completed On-Time Menu of Implementation Strategies

Pressure Ulcer Prevention Menu of Implementation Strategies
  Existing New
On-Time Nutrition Risk Reports
Care Plan Meetings X  
Dietary Department Internal Review   X
MDS Assessment Documentation   X
Nurse Shift Change Report X  
Root Cause Analysis for New Pressure Ulcers   X
Skin Rounds   X
Weekly Nutrition Risk Huddle X  
Weekly Risk Meetings   X
Weekly Wound Review Meetings* X combined with #10  
Wound Rounds* X combined with #9  
On-Time Weight Summary Report
Care Plan Meetings X  
Dietary Department Internal Review   X
MDS Assessment Documentation   X
Risk Management Meetings X Quarterly  
Root Cause Analysis for New Pressure Ulcers   X
Skin Rounds   X
Weekly Nutrition Risk Huddle X  
Weekly Risk Meetings   X
Weekly Wound Review Meetings* X combined with #10  
Wound Rounds* X combined with #9  
On-Time Intervention History for Nutrition Risk Report
Care Plan Meetings X  
Dietary Department Internal Review   X
MDS Assessment Documentation   X
Risk Management Meetings X Quarterly  
Root Cause Analysis for New Pressure Ulcers   X
Weekly Nutrition Risk Huddle X  
Weekly Risk Meetings (e.g., Pressure Ulcer Risk, Nutrition Risk)   X
On-Time Pressure Ulcer Trigger Summary Report: Resident Level
Care Plan Meetings X  
CNA Shift Change Report X  
MDS Assessment Documentation   X
Rehab Department Internal Review X combined with #6  
Restorative Care Internal Review   X
Weekly Risk Huddle for Nurse and Rehab X combined with #4  
Weekly Nutrition Risk Huddle X  
Weekly Risk Meetings (e.g., Pressure Ulcer Risk, Nutrition Risk)   X
Weekly Wound Review Meetings* X  
On-Time Pressure Ulcer Trigger Summary Report: Unit Level    
Restorative Care Internal Review   X
Risk Management Meetings X Quarterly  
Root Cause Analysis for New Pressure Ulcers   X
On-Time Risk Change Report    
Care Plan Meetings X  
CNA Shift Change Report X  
Dietary Department Internal Review   X
MDS Assessment Documentation   X
Nurse Shift Change Report X  
Rehab Department Internal Review X combined with #10  
Restorative Care Internal Review   X
Root Cause Analysis for New Pressure Ulcers   X
Skin Rounds   X
Weekly Risk Huddle for Nurse and Rehab X combined with #6  
Weekly Risk Meetings (e.g., Pressure Ulcer Risk, Nutrition Risk)   X
Weekly Wound Review Meetings* X combined with #13  
Wound Rounds* X combined with #12  
On-Time Resident Clinical, Functional, and Intervention Profile Report – 4-Week View
Care Plan Meetings X  
Dietary Department Internal Review   X
MDS Assessment Documentation   X
Restorative Care Internal Review   X
Risk Management Meetings X Quarterly  
Root Cause Analysis for New Pressure Ulcers   X
Weekly Risk Meetings (e.g., Pressure Ulcer Risk, Nutrition Risk)   X
Weekly Wound Review Meetings* X  

* Although the focus of the meeting is not strictly for prevention, some of the prevention reports can provide helpful information about residents' risks that affect healing as well as prevention, and may help prevent additional pressure ulcers (e.g., nutrition and incontinence status).

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Review of the Change Team's Process of Choosing On-Time Reports, Incorporating Them Into Huddles and Meetings, and Piloting Those Meetings: Unscripted Exercise #2

Communication Practices Grid from Self-Assessment Worksheet for use with Unscripted Exercise #2

Section 3: Communication Practices
  1. We are interested in how you communicate the pressure ulcer risk and prevention care plans to the interdisciplinary team. Please review the following list of meetings. For every meeting that occurs at your facility, indicate how often it occurs, who leads the meeting, and who attends.
Meeting Pressure Ulcer Prevention Discussed Yes/No Meeting Chair/Leader Name and Discipline Staff Invited and in Attendance (indicate A – Always, V- Varies as needed) Frequency of Meeting (Weekly, Biweekly, Monthly, Quarterly, Change in Condition, As Needed)
a. Care plan review No ADON Nursing – A
Social Services – A
Activities – A
Rehab – V
Dietitian – A
Weekly
b. Report or brief with CNAs No Nurse Manager Nursing Assistants – A Every shift
c. Report or brief with department heads No Administrator Department heads (Nursing, Activities, Social Service, Rehab, Dietary, Maintenance and Housekeeping) – A Every morning
d. Medical staff No N/A N/A N/A
e. QAPI* or performance improvement plan meeting Yes, if pressure ulcers are a problem DON Department heads and medical director – A Quarterly
f. Skin or wound meeting No, unless the resident has a pressure ulcer Wound care nurse Nursing – A Weekly
g. MD/APRN* rounds No N/A N/A N/A
h. Report or brief with Dietary Department No Dietitian Dietitian and DON Weekly
i. Report or brief with Social Services Department No N/A N/A N/A
j. Report or brief with Therapy Department No Rehab Director Rehab Director and DON Weekly
k. Report or brief with "Other"        

* QAPI = Quality Assessment and Performance Improvement; APRN = advanced practice registered nurse.

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Review of the Change Team's Process of Choosing On-Time Reports, Incorporating Them Into Huddles and Meetings, and Piloting Those Meetings: Unscripted Exercise #2

Suggested Prompts for Facilitator

Use these questions if change team is not making sufficient progress. It is important that the team can articulate why they have chosen a particular huddle or meeting and why they have chosen the reports to use in that meeting.

Which meetings should be used to pilot reports?

  • Remind the change team that the Communication Practices grid (Self-Assessment) helps identify existing meetings that can be used to help promote pressure ulcer prevention.
  • Ask the team what report they want to use as suggested in the Menu of Implementation Strategies or the Meeting Descriptions document. These tools are there to help the team appropriately match reports with meetings.
  • Given their current meetings, ask the team which meetings they think would be improved with discussion of On-time report results. Which reports would be most useful?
  • Ask them how the reports would be used. For example, would the report be useful at a weekly nutrition risk meeting to provide timely information on weights or average meal intake?
  • Ask the team to pick a meeting they may already have that is listed in the Meetings Description document and identify reports that are recommended and get a discussion going on how that information may be helpful.
  • Remind them that more than one report may be used at a meeting. The Meeting Descriptions document may help them see that. For example, the Nutrition Risk Reports and Weight Summary Reports are often used together.

Will the report be introduced at an existing meeting or will a new meeting be needed?

  • How will existing meetings be adjusted to accommodate report(s).
  • Who should attend the meetings and how will the meetings be kept manageable and focused?

Additional points to make when they are deciding who should be involved in the meeting

  • The Nurse Manager for the unit selected should be supportive or active with the change team. The composition of a meeting depends on its content. You want representation from all relevant disciplines.
  • You may need the staff educator on the team if nursing assistant documentation is not sufficiently complete (must be 75% complete for reports to generate).

Determining which units will implement On-Time? Ask questions so they think about why a unit is picked. Additional points:

  • Units selected for implementation should have stable leadership, with no recent leadership changes. Leadership should be supportive.
  • Units may be selected based on having high pressure ulcer rates.
  • Staff on selected units should be comfortable pulling reports from the EMR.
  • If On-Time is implemented on more than one unit, the units may want to collaborate.

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Return to Pressure Ulcer Prevention

Page last reviewed December 2014
Page originally created March 2013
Internet Citation: AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention. Content last reviewed December 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/pruprev/prev-handouts3.html