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

Functional Specifications

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

3.4. Trigger Summary Report: Resident Level

3.4.1. Report Description

There are two Trigger Summary Reports. Each report uses the same risk variables; the Resident Level report displays resident-specific data for a specified nursing unit and the Unit Level report displays risk for the entire census of a single nursing unit.

Each report displays residents who have at least one trigger activated during the report week presented in descending order of total number of pressure ulcer triggers for the report week. The report displays the prior week trigger totals and the current total, and provides a weekly snapshot of a resident’s risk for pressure ulcer development. These triggers are derived primarily from electronic CNA documentation.

3.4.2. Dependencies and Clinical Assumptions

3.4.2.1. Resident weights are recorded in the EMR.

3.4.2.2. Electronic daily documentation by CNA staff is required for the following:

  • Meal Intake.
  • Bowel.
  • Bladder.

3.4.2.3.  Weekly wound assessments are recorded in the EMR.

3.4.2.4.  Physician order entry or nurse documentation is required for the following:

  • Foley Catheter.

3.4.3. Report Example

Name Room Wt Loss ≥5% in Prior 30 Days (Any) Wt Loss ≥7.5% in Prior 90 Days (Point-to-Point) Wt Loss ≥10% in Prior 180 Days (Point-to-Point) 2 Meals ≤50% in 1 Day Weekly Meal Intake Average <50% Daily Urinary Incont >3 Days Bowel Incont Foley Catheter Current Pressure Ulcer # of Triggers Last Week # of Triggers This Week
Res1 330       X X X X     3 4
Res2 311 X     X -   X X   2 4
Res3 321 X X   X X   X     5 5
Res4 309     X   X X X     0 4
Res5 312     X - X X X     2 4
Res6 320   X   X - - X     0 3
Res7 342 X     X X         3 3
Res8 337       X   X X     2 3
Res9 301       X X X       1 3
Res10 316       X   X -   X 2 3
Total   3 2 2 8 6 6 7 1 1    

3.4.4. Valid Input, Calculations, and Displays

3.4.4.1.  Completeness of main categories for each resident must be >75% in order to calculate the triggers.

3.4.4.2.  There are nine criteria for pressure ulcer risk. Only residents having at least one of the nine criteria during the report week will display on this report.

3.4.4.3.  Sort the residents in descending order of the number of triggers for the current report week and then alphabetically by resident last name.

3.4.4.4.  Display a dash (-) in cells when there is insufficient documentation to compute values.

3.4.4.5.  For calculations in sample report, assume 35 residents on the nursing unit (denominator = 35) and 10 residents meet criteria for risk and display on the report.

3.4.4.6. Use the same rules, calculations, and displays for weights as described for the Weight Summary Report in 3.3.4 for the following cells:

  • Wt Loss ≥5% in Prior 30 Days (Any).
  • Wt Loss ≥7.5% in Prior 90 days (Point-to-Point).
  • Wt Loss ≥10% in Prior 180 Days (Point-to-Point).
Report Column Data Source Valid Input & Display
Wt Loss ≥5% Prior 30 Days (Any) Vital Signs or Weight documentation Use same calculations as used in Weight Summary Report.
The calculations below will identify ANY weight loss within the last 30 days.
Static Week Calculation:

  • Take weights/dates identified in Weight for Week columns (found in Weight Summary Report; 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 the nearest 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 the nearest 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 the nearest one decimal place.
  • Display X if any iteration calculation ≥5%.

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 .056x100=5.6% and .050x100=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, yielding .055x100=5.5%. Display with X.
Wt Loss ≥7.5% in Prior 90 days (Point-to-Point) Vital Signs or Weight documentation Note: Use same calculations as used in Weight Summary Report.
Displays weight loss ≥7.5% in 90 days.
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.
  • Take Weight 90 Days Prior value (calculated above), 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.
  • Display X if ≥7.5%
Wt Loss ≥10% in prior 180 Days (Point-to-Point) Vital Signs or Weight documentation Note: Use same calculations as used in Weight Summary Report.
Displays resident weight loss ≥10% in the last 180 days.
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. Take Weight 180 Days Prior value (calculated above), and subtract 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.
  • Display X if ≥10%
2 Meals ≤50% in 1 Day CNA documentation of meal intake Display X if meal intake is ≤50% for two meals in one day. Do not display X if:

  • Resident refused meal or has NPO status.
  • Resident is on tube feeding.
  • Meal intake value is missing, i.e., if dietitian tech did not document.
  • In the Meal Intake field, there should be an option of Unavailable, LOA, etc., that can be selected when the resident is not present during mealtime. This option should be counted as complete documentation for the meal but should not be used toward the 2 meals ≤50% count.
Weekly Meal Intake Average <50%  CNA documentation of meal intake If meal intake completeness is <75% for the current week, then display a dash, -, for the resident.
Use calculation from the Nutrition Report.

  • Average meal intake (includes breakfast, lunch, dinner) for each week of the 4 most recent weeks displayed in trended view.
  • If meal intake is documented in ranges, then the middle of the range should be the value used in the average calculation. For example, if a range is 51-75%, the percent value used would be 63%.
  • If an option of Refused Meal or NPO is selected, the value used in the average calculation should be zero.
  • Tube Feed should be set as an indicator (yes/no) and NOT contribute to meal intake calculations.
  • Missing meal intake value, i.e., if dietitian tech did not document, no value should contribute to the average calculation.
  • In the Meal Intake field, there should be an option of Unavailable, LOA, etc., that can be selected when the resident is not present during mealtime. This option should be counted as complete documentation for the meal but should not contribute a zero to the average meal intake.
  • If the weekly meal intake average is <50%, then display an X.
Daily Urine Incontinence CNA documentation of resident bladder habits If resident has ≥1 episodes of urinary incontinence each day for the current week, then display an X.
>3 Days Bowel Incontinence CNA documentation of resident bowel habits If resident has ≥1 episode of bowel incontinence for >3 days during the current week, then display an X.
Foley Catheter Physician Orders or nurse documentation
  1. Capture from daily documentation: If "Foley catheter" is entered at least once during current week, then display an X.
  2. Capture from orders: if active order for catheter, then display X (details of each system vary; may be from physician or nurse orders).
Current Pressure Ulcer Nurse Wound Assessment If the resident has at least one pressure ulcer for the current week, then display an X.
# of Triggers Last Week Prior Week Total from Trigger Summary Report: Resident Level Carry forward the total number of triggers (columns listed above) that the resident had for the previous week and display count in the column.
Note: If unable to store previous count, then recalculate using same rules.
# of Triggers This Week   For each resident on the report, count the number of X’s and display count.
Total   For each column on the report (i.e., Wt Loss ≥5% in Prior 30 Days (Any), Wt Loss ≥10% in Prior 180 Days, 2 Meals ≤50% in 1 Day, Weekly Meal Intake Average <50%, Daily Urine Incontinence, >3 Days Bowel Incontinence, Foley Catheter, and Current Pressure Ulcer), count the number of X’s and display count.

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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-functspecs3-4.html