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New care tracking tool helps identify nursing home patients at risk for pressure ulcers

Despite knowledge of clinical guidelines to prevent and treat pressure ulcers among nursing home residents, it remains difficult for staff to integrate this knowledge into their daily work. A new pressure ulcer reduction program, the On-Time Quality Improvement for Long Term Care (On-Time), was developed by the Agency for Healthcare Research and Quality (AHRQ) with support from the California Health Care Foundation, to close the gap between staff knowledge and staff practice.

The On-Time program uses a set of newly developed tools that staff may adapt and integrate into their current processes and structures, explains AHRQ researcher William Spector, Ph.D. The tools include a daily care documentation form completed by certified nursing assistants (CNAs), an audit report of the form's completeness, and four weekly clinical reports that help identify residents at high risk for developing pressure ulcers.

The heart of the program lies in the CNA daily reports on care relevant to pressure ulcer risk factors such as nutrition and behavior. The data are stored in a database, which then produces clinical reports that can be used by nurses, dietitians, physicians, and other professionals providing resident care. The reports summarize information about residents' nutritional status, behavior, pressure ulcer triggers (such as substantial weight loss, daily urinary incontinence, or presence of a Foley catheter), and priority areas for intervention. The On-Time reports identify residents at highest risk for pressure ulcer development, show trends in outcomes for these residents over time, help staff monitor the effectiveness of care in a timely fashion, and foster teamwork and communication.

Two preliminary evaluations of the program showed that it reduced high-risk pressure ulcer quality measures by 33 percent in a span of 18 months and 13 percent in 6 months.

Reprints (AHRQ Publication No. 08-R084) are available from the AHRQ Publications Clearinghouse. See "Pressure ulcer plan is working," by Sandra Hudak, M.S., R.N., Siobhan Sharkey, M.B.A., Michal Engleman, M.H.S., and others, in the May 2008 Provider, pp. 34-39.

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