Real Time Pressure Ulcer Incidence Drives Quality Improvement

Purpose:
In addition to quarterly NDNQI Prevalence and Incidence data collection on pressure ulcers, our institution has implemented a system of collecting real time incidence of pressure ulcers. Together, the two measurements provide comprehensive analysis of pressure ulcer issues and improve quality.

Significance:
National pressure ulcer quality standards recommend measurement of quarterly P&I (NDNQI,IHI,NPUAP) to provide quality comparisons internally and externally. Now, further regulatory and safety intitiatives necessitate real time pressure ulcer data analysis to drive rapid refinements in care.

Strategy and Implementation:
Real time pressure ulcer data is collected from a variety of sources including:electronic and phone request for wound consultation,wound rounds case finding,event reporting. Certified wound nurse team evaluates patients and verifies/collaborates/determines staging and plan of care. Daily, weekly and monthly hospital acquired and prevalence statistics are compiled and analyzed via a combination of wound census, home grown database, manual entry and limited interface with EMR. Unit based data are posted on hospital intranet quality icon site and distributed to managers and quality facilitators for monthly unit-based quality meetings. Data is analyzed for root cause by the monthly Performance Improvement Nursing Council. Hospital-wide Quality Council reviews reports quarterly and benchmarks on a dashboard. Horizontal service line pressure ulcer outcome was analyzed for the cardiac surgery, orthopedic, trauma and rehabilitation programs resulting in specific care improvement initiatives.

Evaluation:
Over 16 months,real time pressure ulcer data converged with quarterly NDNQI P&I data,validating the methodology.Considerable variation exists in the rates of pressure ulcers when monitored on a real time basis.Distribution of real time data to caregivers affords rapid quality improvement cycles.

Implications for Practice:
Quarterly prevalence and incidence pressure ulcer data is helpful for basic quality benchmarking but may need to be supplemented with more detailed real time rate analysis in order to meet demands of increased regulatory, financial and safety goals.