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

Functional Specifications

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

3.6. Risk Change Report (formerly Priority Report)

3.6.1. Report Description

The On-Time Risk Change Report (formerly Priority Report) uses 6 criteria: decrease in meal intake, loss of weight, increase in bladder incontinence, increase in number of behaviors or change in behaviors from prior week, new or worsening pressure ulcer, and new pressure ulcer. Residents with a change in one or more of these criteria from the previous week will display on the report.

3.6.2. Dependencies and Clinical Assumptions

3.6.2.1. Use calculations for Nutrition Risk Report for the following cells:

  • Decreased Meal Intake + Weight Loss.
  • Decreased Meal Intake.

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

  • Weight Loss ≥5% in Prior 30 Days.

3.6.3. Report Example

Name Room
Number
Nutrition Risk Change Within 7 Days
Increase in Incontinence ADL Decline ≥3 Behaviors Pressure Ulcer Health Status#

De- creased Meal Intake + Weight Loss

De- creased Meal Intake

Weight Loss ≥5% in Prior 30 Days Urine Bowel# Bed Mobility Transfer Toilet- ing Change in Be- havior Types From Prior Week (*) Worsen- ing Ulcer New Ulcer Acute Change in Status
Resident 1 202     X           7*      
Resident 2 212   X   X     X X       X
Resident 3 217 X     X X       3      
Resident 4 229     X     X            
Resident 5 231 X   X               X  
Resident 6 242     X                  
Resident 7 243                 4 X    

Note: If three or more behaviors for a resident were documented during the current week then the number of behaviors will display;
* An asterisk will display next to the number of behaviors if the behaviors recorded during the current report week are different from behaviors recorded during the prior week.
# indicates column added in 2014.

3.6.4. Valid Input, Calculations, and Displays

3.6.4.1.  Completeness of CNA documentation of meal intake for each resident for the report week must be >75% in order to calculate the triggers for Decreased Meal Intake + Weight Loss and Decreased Meal Intake.

3.6.4.2.  Completeness of CNA documentation of resident bladder and bowel habits for each resident for the report week must be >75% in order to calculate the triggers for Increase in Incontinence: Bladder and Increase in Incontinence: Bowel.

3.6.4.3.  Decreased Meal Intake + Weight Loss are two risk criteria used to determine nutrition risk on the Nutrition Risk Reports.

  • Residents who meet both criteria will display on the Nutrition High Risk Report and on this report; an X will display in the column "Decreased Meal Intake + Weight Loss."
  • Residents who meet the nutrition risk criteria for decreased meal intake will display on the Nutrition Medium Risk Report and on this report; an X will display in the "Decreased Meal Intake Column."

3.6.4.4.  Calculations to determine increase in urinary and bowel incontinence are provided in two ways to support the ways CNAs may record incontinence at their facility (see details in the table below):

  • Number of shifts incontinent episodes occurred.
  • Number of times the resident was incontinent per shift.

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

3.6.4.6.  Display in the report footer:

* An asterisk will display next to the number of behaviors in the column "Change in Behavior Types From Prior Week" if the behaviors recorded during the current report week are different from behaviors recorded during the prior week.

 

Report Column Data Source Valid Input & Display
Decreased Meal Intake + Weight Loss Vital Signs or Weight documentation and CNA documentation of meal intake or use Nutrition High Risk Flag If Nutrition High Risk is TRUE then display an X.
If there is incomplete CNA documentation of meal intake, then display a dash).
Decreased Meal Intake CNA documentation of meal intake or use Nutrition Medium Risk Flag for decreased meal intake If Nutrition Medium Risk is TRUE for decreased meal intake, then display an X.
If there is incomplete CNA documentation of meal intake, then display a dash.
Wt Loss ≥5% in Prior 30 Days Vital Signs or Weight documentation or use Weight Loss Flag If resident Weight Loss flag is TRUE, then display an X or use the same calculation used in Weight Summary Report.
Increase in Incontinence: Urine   If bladder completeness is <75% for the current and/or prior week, then display a dash for the resident.
To calculate an increase in urinary incontinence by shift (yes/no):

  • For the current week, count the number of shifts a resident had at least one episode of urinary incontinence documented by the CNA.
  • For the prior week, count the number of shifts a resident had at least one episode of urinary incontinence documented by the CNA.
  • If the number of shifts with urinary incontinence increased by three or more (Current − Previous≥3), then display an X for the resident.

To calculate an increase in urinary incontinence by the number of times per shift:

  • For the current week, sum the number of urinary incontinence episodes documented by the CNA.
  • For the prior week, sum the number of urinary incontinence episodes documented by the CNA.
  • If the number of urinary incontinence episodes increases by 12 or more (Current − Previous≥12), then display an X for the resident.
Increase in Incontinence: Bowel   If bowel completeness is <75% for the current and/or prior week, then display a dash for the resident.
To calculate an increase in bowel incontinence by shift (yes/no):

  • For the current week, count the number of shifts a resident had at least one episode of bowel incontinence documented by the CNA.
  • For the prior week, count the number of shifts a resident had at least one episode of bowel incontinence documented by the CNA.
  • If the number of shifts with bowel incontinence increased by one or more (Current − Previous≥1), then display an X for the resident.

To calculate an increase in bowel incontinence by the number of times per shift:

  • For the current week, sum the number of bowel incontinence episodes documented by the CNA.
  • For the prior week, sum the number of bowel incontinence episodes documented by the CNA.
  • If the number of bowel incontinence episodes increases by 2 or more (Current − Previous≥2), then display an X for the resident.
ADL Decline: Bed Mobility CNA documentation of ADLs If ADL completeness is <75% for the current and/or prior week, then display a dash for the resident.
CNA documentation options/abbreviations:
Use self-performance responses.

  • Independent (IN)
  • Supervision (SU)
  • Limited Assistance (LA)
  • Extensive Assistance (EA)
  • Total Dependence (Total)
  • Activity Did Not Occur (NO)

Using above options, determine the PRIOR WEEKLY value by taking the highest (or worst) value recorded for that week to identify PRIOR WEEK VALUE. DO NOT USE Activity Did Not Occur (NO) to calculate weekly value. If values are only NO, then a value cannot be determined. Leave ADL Decline: Bed Mobility blank.
Repeat as above to determine value for the CURRENT WEEK.
Compare PRIOR WEEK VALUE to CURRENT WEEK VALUE to determine ADL Decline: Bed Mobility as TRUE or FALSE. IF the current week value is higher than the prior week value, then ADL Decline: Bed Mobility = TRUE.
For example:
> IF PRIOR WEEK = IN and CURRENT WEEK = SU or LA or EA or Total, then ADL Decline: Bed Mobility is TRUE and an X displays.
IF PRIOR WEEK = EA and CURRENT WEEK = IN or SU or LA, then ADL Decline: Bed Mobility is FALSE and the cell is BLANK.
IF PRIOR WEEK or CURRENT WEEK = NO, then do not compare values and leave the cell BLANK.

ADL Decline: Transfer CNA documentation of ADLs Repeat steps as above for Bed Mobility.
ADL Decline: Toileting CNA documentation of ADLs Repeat steps as above for Bed Mobility.
Behaviors ≥3 CNA documentation of resident behaviors If behavior completeness is <75% for the current and/or prior week, then display a dash for the resident.
 

  • For the current week, count the number of unique behavior types documented. The behavior only has to be documented once during a shift to be included in the count of unique behavior types.
  • Store the different behavior types.
  • Count the number of behaviors recorded and if more than 3 behaviors, then display count value.
  • For the prior week, store each behavior type documented for the resident.
  • Compare the behavior types from the current week to the prior week.
  • If the current week has any behavior types documented that were not documented in the prior week, place an asterisk by the number of different behaviors documented for the resident.
Worsening Ulcer Wound Assessment If wound assessment occurred in last 7 days and prior to report date and data field "Ulcer Status" = worsened, then display X.

Note: Data source depends on the EMR vendor’s wound assessment; refer to the EMR vendor for exact data source.

New Ulcer Wound Assessment If ulcer onset date within 7 days and prior to report date, then display an X.
Acute Change in Status May differ by EMR vendor. Refer to the EMR vendor for best source to determine an acute change in resident clinical condition within 7 days and prior to report date.
Example sources: nurse change in condition documentation or 24 hour report.
Risk Factors: Total   Count the number of X’s in a row for a single resident 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-functspecs3-6.html