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

Functional Specifications

3. Specifications for Each Pressure Ulcer Prevention Report (continued)

3.3. Weight Summary Report

3.3.1. Report Description

The Weight Summary Report displays 4 weeks of trended weight information for each resident, calculates weight changes, and displays whether there have been measurable weight loss percentages (more than 2 percent, 5 percent, 7.5 percent, and 10 percent) for the past 7, 30, 90, and 180 days).

3.3.2. Dependencies and Clinical Assumptions

3.3.2.1. Resident weights are stored in the EMR.

3.3.2.2. Active residents only display for a single nursing unit.

3.3.3. Report Example

Resident Name Resident ID Weight 180 Days Prior Weight 90 Days Prior Weight 30 Days Prior Weight for Week 5/8/14 Week4 Weight for Week 5/15/14 Week3 Weight for Week 5/22/14 Week2 Weight for Week 5/29/14 Week1 Weight Change lbs / Date ≥2% Wt. Loss (From Previous Week) ≥5 lb Wt Loss in Prior 30 Days ≥5% Wt Loss in Prior 30 Days (Point-to- Point) ≥5% Wt Loss in Prior 30 Days (Any) ≥7.5% Wt Loss in Prior 90 Days ≥10% Wt Loss in Prior 180 Days
A #####1 285.3 275.0 254.5 252.4 256.1 251.7 253.8 2.1, 5/27/14         7.7% 11.0%
B #####2 172.1 175.3 180.0 180.0 170.0 181.0 171.0 −10.0, 5/27/14 5.5%, 9.0 5.0% 5.6%, 5/12/14;
5.0%, 5/27/14
5.5%, 5/27/14
   

3.3.4. Valid Input, Calculations, and Displays

3.3.4.1. Weights are calculated in two ways:

  • Point-to-Point: using two data points to determine if weight loss occurred.
  • Any Weight Loss: using multiple weight comparisons within a specified period to identify "Any" weight loss within the period.

3.3.4.2. Display weight to one decimal point, e.g., 101.5.

3.3.4.3. A date next to a weight loss value indicates the date the weight change occurred.

3.3.4.4. If a weekly weight value is not stored, then a weekly weight cell will be BLANK.

3.3.4.5. If a resident was not weighed during the current week:

  • Weight values that display for 180 days prior, 90 days prior, and 30 days prior are computed using the most recent weight value that is stored in the system.
  • The following cells must be BLANK:
    • Weight for current week.
    • Weight change in pounds/date.
    • ≥2% Wt Loss (From Previous Week).
    • ≥5 lb Wt Loss in Prior 30 Days.
    • ≥5% Wt Loss in Prior 30 Days (Point-to-Point).
    • ≥5% Wt Loss in Prior 30 Days (Any).
    • ≥7.5% Weight Loss in Prior 90 Days.
    • ≥10% Weight Loss in Prior 180 Days.

3.3.4.6. Display in the report footer:

All weight loss calculations are point-to-point unless "Any" is indicated.

Weight 30 Days Prior value may not be the same as Weight for Week 4 because the 30 Days Prior value date may fall outside of Week 4.

Report Column Data Source Valid Input & Display
Weight 180 Days Prior Vital Signs or Weight documentation The weight of the resident approximately 180 days prior to the most recent resident weight.
Static Week Calculation:

  • Identify all weights that occur in the range of 170-190 days from the most recent weight date; multiple weights may be selected.
  • Select the weight that is closest to 180 days from the most recent weight date.
  • If two weights are the same distance from 180 (−10 days or +10 days), select the lower weight.
  • Display weight in pounds rounded to one decimal place.
Weight 90 Days Prior Vital Signs or Weight documentation The weight of the resident approximately 90 days prior to the most recent resident weight.
Static Week Calculation:

  • Identify all weights that occur in the range of 85-95 days from the most recent weight date; multiple weights may be selected.
  • Select the weight that is closest to 90 days from the most recent weight date.
  • If two weights are the same distance from 90 (−5 days or +5 days), select the lower weight.
  • Display weight in pounds rounded to one decimal place.
Weight 30 Days Prior Vital Signs or Weight documentation The weight of the resident approximately 30 days prior to the most recent resident weight.
Static Week Calculation:

  • Identify all weights that occur in the range of 25-35 days from the most recent weight date; multiple weights may be selected.
  • Select the weight that is closest to 30 days from the most recent weight date.
  • If two weights are the same distance from 30 (−5 days or +5 days), select the lower weight.
  • Display weight in pounds rounded to one decimal place.
Weight for Week Vital Signs or Weight documentation Lowest weight for each week in a 4-week period trended view. Week Ending Date should be displayed in the four column headers.

  • If a resident is weighed monthly, some of the weekly weights will be blank.
  • If multiple weights are taken in one week, the lowest weight is used as the weekly weight.

Note: Weight 30 Days Prior value may not be the same as Weight for Week (Week4) because 30 Days Prior value may fall in Week 5. It depends on weight date. Display weight in pounds rounded to one decimal.

Weight Change (lbs) Vital Signs or Weight documentation Change in weight (lbs) from the previous weight to the most recent weight (Most Recent Weight − Previous Weight).

  • Display weight change as + for weight gain; − for weight loss.
  • Display weight change date (weight date used to calculate change).
  • If multiple weights are taken in one week, use the lowest weight as the weekly weight.

Static Week Calculation:

  • The Previous Weight is the next most recent lowest weekly weight within the last 200 days. The Previous Weight does not need to occur in the week just prior to the most recent week. Often residents are on monthly weight schedules, so the Previous Weight may be 4 weeks prior to the Most Recent Weight.
≥2% Weight Loss (From Previous Week) Vital Signs or Weight documentation Displays the weight loss value of a resident with weight loss ≥2% from the previous week to the most recent week (where the 2 weeks are adjacent to one another).
Static Week Calculation:
Take the weight change in lbs from the previous week to the most recent week (most recent − previous)
If weight change is positive, disregard; if negative, take absolute value, and divide by the previous week’s weight. Multiply by 100. Indicate with % sign. Show rounded to one decimal place.
Display value if ≥2%.
≥5 lb Weight Loss in Prior 30 Days Vital Signs or Weight documentation Displays the value of a resident weight loss of ≥5 lbs approximately 30 days prior to the most recent weight.
Static Week Calculation:

  • Take weight change in lbs from Weight 30 Days Prior to most recent weight (most recent − 30 day).
  • If weight change is positive, disregard; if negative, take absolute value.
  • If weight loss ≥5lb, display the weight loss value in lbs.
≥5% Wt Loss in Prior 30 Days (Point-to-Point) Vital Signs or Weight documentation Note: The calculations below will identify weight loss closest to 30 days from most recent weight.
Displays the occurrence of a resident weight loss of ≥5% compared to weight closest to 30 days prior.
Static Week Calculation:

  • Take the value calculated above in ≥5lb Weight Loss in Prior 30 Days, and divide by Weight 30 Days Prior. Multiply by 100. Round to one decimal place.
  • Display the value if ≥5%. Display value as percentage.
≥5% Wt Loss in Prior 30 Days (ANY) Vital Signs or Weight documentation Note: The calculations below will identify ANY weight loss within the last 30 days.
Displays all occurrences of a resident weight loss of ≥5% in the last 30 days.
Static Week Calculation:

  • Take weights/dates identified in Weight for Week columns (one weight/date per week, with up to four per resident).
  • Week 1 is most recent week; week 2 is second most recent; etc.
  • Iteration one: Take week 4 weight and subtract from week 3 through 1 weights (week 3 − week 4, week 2 − week 4, week 1 − week 4); if value is positive, disregard; if negative, take absolute value and divide by week 4 weight. Multiply by 100. Round to one decimal place.
  • Iteration two: Take week 3 weight and subtract from week 2 and 1 weights (week 2 − week 3, week 1 − week 3); if value is positive, disregard; if negative, take absolute value and divide by week 3 weight. Multiply by 100. Round to one decimal place.
  • Iteration three: Take week 2 weight and subtract from week 1 weight (week 1 − week 2); if value is positive, disregard; if negative, take absolute value and divide by week 2 weight. Multiply by 100. Round to one decimal place.

Example:

  • Four weights are taken for a resident: 180.0 on 5/4/14; 170.0 on 5/12/14; 181.0 on 5/19/14; and 171.0 on 5/27/14 (where 5/25- 5/31 is the most recent static week).
  • First iteration yields −10.0, 1.0, and −9.0; take absolute value of −10.0 and −9.0, and divide each by 180.0, yielding .056 x100= 5.6% and.050 x100= 5.0%.
  • Second iteration yields 11.0, 1.0; disregard both values.
  • Third iteration yields −10.0; take absolute value, and divide by 181.0, .055x100= 5.5%.
  • Column output: 5.6%, 5/12/14; 5.0%, 5/27/14; 5.5%, 5/27/14 (displayed above in sample table).
≥7.5% Wt Loss in Prior 90 Days Vital Signs or Weight documentation Displays weight loss ≥7.5% in 90 days.
Static Week Calculation:

  • Take Weight 90 Days Prior value, and subtract from most recent weight (most recent − 90 day).
  • If value is positive, disregard; if negative, take absolute value and divide by Weight 90 Days Prior value. Multiply by 100. Round to one decimal place. Display value if ≥7.5%. Indicate with % sign.
≥10% Wt Loss in Prior180 Days Vital Signs or Weight documentation Displays resident weight loss ≥10% in the last 180 days.
Static Week Calculation:

  • Take Weight 180 Days Prior value, and subtract from most recent weight (most recent − 180 day).
  • If value is positive, disregard; if negative, take absolute value and divide by Weight 180 Days Prior value. Multiply by 100. Round to one decimal place.
  • Display value if ≥10%. Indicate with % sign.
* Physician Orders Indicates resident has active dialysis order.

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Page last reviewed April 2016
Page originally created September 2014
Internet Citation: AHRQ's Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention. Content last reviewed April 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/pruprev/pruprev-functspecs3-3.html