On-Time Pressure Ulcer Healing in Long Term Care

1. 1 On-Time Pressure Ulcer Healing in Long Term Care Track 4: Patient Safety � Improving Quality of Care in Nursing Homes and Long-Term Care Settings September 10, 2008 Presented by Siobhan Sharkey, MBA

2. 2 On-Time PrU Healing Objectives Develop standardized pressure ulcer assessment documentation Develop new reports to support clinical decision making related to pressure ulcer treatment & heal days Translate data elements and clinical reports to HIT requirements Analyze data to determine treatments that are associated with better outcomes.

3. 3 Participants High risk PrU quality measure >8% Total of 25 skilled nursing facilities

4. 4 Background Pressure ulcer healing�a measure of quality: CMS� ultimate goal - use pressure ulcer healing rates as a publicly reported measure of nursing home quality. Debate over how to define �healing.� Current definition in MDS 2.0 is reduction of ulcer stage. �Down-coding� stage as the measure of pressure ulcer improvement/healing has been shown to be inadequate (Miller, 1994; Berlowitz et al, 1997). CMS plans to include a revised measure of pressure ulcer healing in MDS 3.0.

5. 5 Background No easily accessible decision support tools No standardized set of data elements to document weekly skin assessments and treatments No standardized measure of healing. PUSH tool is promoted to measure healing Research suggests that area (length x width) is a more realistic and feasible measure. Existing decision support tools consume large amounts of staff time AND do not assist wound nurses and front-line clinicians to monitor resident and pressure ulcer status and provide treatment based on best practice.

6. 6 Major Tasks Define standardize data elements related to wound and skin assessment and PrU treatments. Trial by actual users. Develop prototype documentation forms for wound nurse. Define clinical decision making reports. Design, test, and refine reports for clinical decision making related to PrU healing. Establish functional requirements for HIT. Collaborate with caregivers to implement new processes of care: documentation, use of clinical decision making reports.

7. 7 Standardized Data Elements: Wound Assessment Ulcer Dimensions Wound Edges Undermining Tunneling Necrotic Tissue Type Necrotic Tissue Amount Drainage/ Exudate Type Drainage/ Exudate Amount Peri Wound Area Peri Wound Edema Peri Wound Induration Granulation Epithelialization Pain Treatments Adjunctive Therapies Interventions Consultation Follow up Ulcer Status Current Visualization Ulcer Stage Resident Disposition

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9. 9 PrU Healing ReportsInitial Definition New and Existing Pressure Ulcer Report. Displays list of residents with new and existing ulcers that are being treated. Stagnant or Worsening Ulcers Report. Displays list of residents with ulcers that have either not improved or worsened during previous 14 days. Pressure Ulcer QI Monitoring Report. Tracks pressure ulcer statistics by ulcer stage and occurrence by nursing station; tracks ulcers > 30 days. Detailed Report of Pressure Ulcer Wound Assessment and Treatment Information. Report displays longitudinal view over time (4 weeks) by resident for ulcers > 30 days.

10. 10 Defining Clinical ReportsExample: QI Monitor How many pressure ulcers were treated this month on nursing Unit A? Unit B? Unit C? Unit D? How many ulcers were Stage I? Stage II? Stage III? Stage IV? Unstageable? How many ulcers healed? How many ulcers developed in-house? How many ulcers were treated for > 20 days? Which nursing unit has the most ulcers of 30 day or longer duration?