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

Functional Specifications

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

3.7. Resident Clinical, Functional, and Intervention Profile Report

3.7.1. Report Description

This report displays 4 weeks of clinical data for a single resident that is captured from electronic CNA daily charting, physician orders, and lab result values.

3.7.2. Dependencies and Clinical Assumptions

3.7.2.1.  This report assumes the EMR vendor can display data for multiple weeks using multiple data sources.

  Week Ending
4/6/14 4/13/14 4/20/14 4/27/14
Vital Signs Number of pressure ulcers 0 1 2 2
Temperature   99.2    
Pulse 82 88 90 100
Respirations 20 20 20 20
Blood pressure 102/58 110/60 102/58 120/88
O2 saturation 96 97 98 88
Weight Weight in pounds 149.2     144
Weight date 3/26/14     4/23/14
Nutrition / Vitamins & Supplements Diet Pureed Pureed Pureed Clear liquids
Tube feeding No No No No
Supplements No Ensure Ensure Ensure
Multivitamin No No No Yes
Vitamin C No Yes Yes Yes
Arginaid No No No No
Zinc No No No No
Protein No No Yes Yes
Weekly average meal intake - percent        
Breakfast 88 78 62 75
Lunch 79 74 25 25
Dinner 65 55 45 35
Nutritional supplement – percent        
Breakfast 25 50 25 25
Lunch 25 25 25 25
Dinner 0 25 0 0
Bowel Habits Continent Continent Incontinent Incontinent
Loose stool No No Yes Yes
Incontinence        
# shifts / week 0 0 12 18
Daily incontinence       X
3 days without BM   X   X
Bladder Habits Incontinent Incontinent Incontinent Incontinent
Catheter Condom No No Foley
Ostomy No No No No
Incontinence        
# shifts / week 9 12 12 14
Daily incontinence No No Yes Yes
Did not void # shifts / week 0 0 0 1
Restorative Bowel No No No No
Bladder No No Yes Yes
Eating No No No No
Mobility No No No No
Self-Performance / Support Provided2 Bed mobility EA/1 EA/1 EA/1 EA/2
Transfer EA/1 EA/1 EA/1 EA/2
Locomotion EA/1 EA/1 EA/1 EA/2
Dressing LA/set up EA/1 EA/1 EA/1
Eating LA/set up EA/1 EA/1 EA/1
Personal hygiene LA/set up EA/1 EA/1 EA/1
Toileting EA/1 EA/1 EA/1 EA/2
Labs1 Pre-Albumin (19.5-35.8 mg/dL) 33.0   21.6  
Albumin (3.4-5.4 g/dL) 3.4 3.6 5.8* 6.2*
Sodium (135-145 mEq/L) 128* 122* 114* 120*
Potassium (3.5-5.2 mEq/L) 4.0 4.3 4.4 4.3
Creatinine (0.7-1.3 mg/dL) 0.6* 0.7 1.0 1.8*
BUN (6.0-20.0 mg/dL) 6.0 6.2 6.0 6.1
Transferrin (20-50%) 20 25 35 35
Bed Surfaces Air fluidized surface X X X X
Dynamic/alternating pressure        
Low air loss        
Replacement mattress        
Chair Surfaces Fluid filled or gel cushions X X X X
Foam cushions        
Combination cushions        
Other Heel boots X X X X

 

3.7.4. Valid Input, Calculations, and Displays

3.7.4.1. If multiple data sources are listed, then the facility determines the best source to use for their organization.

Report Column Data Source Valid Input & Display
Vital Signs
Number of pressure ulcers Wound Assessment Count number of unique pressure ulcers and display count.
Temperature Vital Signs Display temperature in Fahrenheit or Celsius, per facility standard. Display xxx.x or xx.x. No leading zeroes.
Pulse Vital Signs Display pulse value as xx or xxx. No leading zeroes.
Respirations Vital Signs Display respiration value as xx.
Blood pressure Vital Signs Display blood pressure value as systolic blood pressure / diastolic blood pressure xxx/xxx, no leading zeroes.
O2 saturation EMR vendor determines source, if available Display oxygen saturation as percentage value as xx.
Weight
Weekly weight in pounds Vital Signs or Weight documentation Display weight value in pounds unless facility uses other metric and display pounds as xxx.x. No leading zeroes.
Weight date Vital Signs or Weight Documentation Display weight date of lowest weekly weight value. See Weight Summary Report for description and instructions to determine weekly weights.
Nutrition/Vitamins & Supplements
Diet Physician Orders Display diet name.
Tube feeding Physician Orders If there is a physician order for tube feeding, then display as yes or no.
Supplements Physician Orders If there is a physician order for a nutritional supplement, then display the name of the supplement ordered; if no order, then display "no."
Multivitamin Physician Orders If there is a physician order for Multivitamins, then display "yes"; if no order, then display "no."
Vitamin C Physician Orders If there is a physician order for Vitamin C, then display "yes"; if no order, then display "no."
Arginaid Physician Orders If there is a physician order for Arginaid, then display "yes"; if no order, then display "no."
Zinc Physician Orders If there is a physician order for Zinc, then display "yes"; if no order, then display "no."
Protein Physician Orders or Dietitian Referral If there is a physician order or if the dietitian prescribes Protein to supplement the diet order, then display "yes"; if not prescribed, then display "no."
Weekly average meal intake – percent
Breakfast
Use calculations in Nutrition Report for computing average meal intake values Display average meal intake percentage as xx.
Lunch   Display average meal intake percentage as xx.
Dinner   Display average meal intake percentage as xx.
Nutritional supplement – percent
Breakfast
Use calculations in Nutrition Report for computing average meal intake values Display average supplement intake percentage as xx.
Lunch   Display average supplement intake percentage as xx.
Dinner   Display average supplement intake percentage as xx.
Bowel
Habits CNA documentation of bowel habits If any bowel incontinence documented during the report week, then display "incontinent"; otherwise, display "continent."
Loose stool CNA documentation of bowel habits or nurse documentation If any loose stool documented during the report week, then display "yes"; otherwise, display "no."
Incontinence CNA documentation of bowel habits  
# shifts / week CNA documentation of bowel habits Count the number of shifts bowel incontinence recorded during the report week and display count as xx; maximum value = 21 if 8 hour shifts or 3 shifts per day; maximum value = 14 if 12 hour shifts or 2 shifts per day. Refer to facility schedule.
Daily incontinence CNA documentation of bowel habits If bowel incontinence documented at least one shift each day during the report week, then display "yes"; otherwise, display "no."
3 days without BM CNA documentation of bowel habits If "no bowel movement" selected for 9 consecutive shifts during report week and facility shifts = 8 hours, then display X.
If 6 consecutive shifts during report week and facility shifts = 12 hours, then display X.
Bladder
Habits CNA documentation of bladder habits If any bladder incontinence documented during the report week, then display "incontinent"; otherwise, display "continent."
Catheter Physician Orders or CNA documentation of bladder habits If Foley or external catheter used during the report week, then display X.
Ostomy Physician orders or CNA documentation of bladder habits If Ostomy used during the report week, then display X.
Incontinence CNA documentation of bladder habits  
# shifts / week CNA documentation of bladder habits Count the number of shifts bladder incontinence recorded during the report week and display count as xx; maximum value = 21 if 8 hour shifts or 3 shifts per day; maximum value = 14 if 12 hour shifts or 2 shifts per day. Refer to facility schedule.
Daily incontinence CNA documentation of bladder habits If bladder incontinence documented at least one shift each day during the report week then display "yes"; otherwise, display "no."
Did not void # shifts / week CNA documentation of bladder habits Count the number of shifts "did not void" selected and display count; display as xx.
Restorative
Bowel Physician Orders or Nurse Orders or nurse notes or restorative notes If restorative program for bowel in place during the report week, then display. "yes"; otherwise, display "no."
Bladder Physician Orders or Nurse Orders or nurse notes or restorative notes If restorative program for bladder in place during the report week, then display "yes"; otherwise, display "no."
Eating Physician Orders or Nurse Orders or nurse notes or restorative notes If restorative program for eating in place during the report week, then display "yes"; otherwise, display "no."
Mobility Physician Orders or Nurse Orders or nurse notes or restorative notes If restorative program for mobility in place during the report week, then display "yes"; otherwise, display "no."
Self Performance/Support Provided
Bed Mobility CNA documentation of ADL Use the following responses for self-performance and support provided for bed mobility, transfer, locomotion, dressing, eating, personal hygiene, and toileting:

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

Self Performance Value:

  • Check documentation entries for the report week and display the highest level or most dependent value recorded for the report week. Total dependence = highest level, independent = lowest level. List of documentation options and abbreviations are below.
  • Use the following support provided responses:
    • No setup (None)
    • Set up only (Set up)
    • One person (1)
    • Two person (2)
    • Activity Did Not Occur (NO)

Support Provided Value:

  • Check documentation entries for the report week and display the highest level or most dependent value recorded for the report week. "Two person (2)" is highest value and No setup (None) is the lowest value.
  • Display self-performance responses first, divided by slash (/). For example, a resident requiring extensive assistance with the help of two people would display as EA/2.
Transfer CNA documentation of ADL See instructions for Bed Mobility.
Locomotion CNA documentation of ADL See instructions for Bed Mobility.
Dressing CNA documentation of ADL See instructions for Bed Mobility.
Eating CNA documentation of ADL See instructions for Bed Mobility.
Personal Hygiene CNA documentation of ADL See instructions for Bed Mobility.
Toileting CNA documentation of ADL See instructions for Bed Mobility.
Labs
Pre-Albumin (19.5-35.8 mg/dL Lab Results If the EMR vendor stores lab values, then display value closest and prior to report ending date for the report week. Provide indicator for out-of-range values; above average and below average indicator. Display Pre-Albumin value as xx.x mg/dL.
Albumin (3.4-5.4 g/dL) Lab Results Display Albumin value as x.x.
Sodium (135-145 mEq/L) Lab Results Display Sodium value as xxx.
Potassium (3.5-5.2 MEq/L) Lab Results Display Potassium value as x.x.
Creatinine (0.7-1.3 mg/dL) Lab Results Display Creatinine value as x.x.
BUN (6-20 mg/dL) Lab Results Display BUN value as x.x.
Transferrin (20-50%) Lab Results Display Transferrin percentage value as xx.
Bed Surfaces
Air fluidized surface Physician Orders If there is a physician order for air fluidized surface, then display "X"; otherwise, leave blank. If physician order not required, then facility determines source.
Dynamic/alternating pressure Physician Orders If there is a physician order for dynamic/alternating pressure surface, then display "X"; otherwise, leave blank. If physician order is not required, then facility determines source.
Low air loss Physician Orders If there is a physician order for low air loss bed surface, then display "X"; otherwise, leave blank. If physician order is not required, then facility determines source.
Replacement mattress Physician Orders If there is a physician order for replacement mattress, then display "X"; otherwise, leave blank. If physician order is not required, then facility determines source.
Chair Surfaces
Fluid filled or gel cushions Physician Orders If there is a physician order for fluid filled or gel cushions then display "X"; otherwise, leave blank. If physician order is not required, then facility determines source.
Foam cushions Physician Orders If there is a physician order for foam cushions, then display "X"; otherwise, leave blank. If physician order is not required, then facility determines source.
Combination cushions Physician Orders If there is a physician order for combination cushions, then display "X"; otherwise, leave blank. If physician order is not required, then facility determines source.
Other
Heel boots Physician Orders If there is a physician order for heel boots, then display "X"; otherwise, leave blank. If physician order is not required, then facility determines source.

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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-functspecs3-7.html