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To decrease the hospital acquired pressure ulcer (HAPU) incidence by enhancing communication through the use of electronic health records (EHR) to generate accurate real time information concerning patient pressure ulcer (PU) risk and current status.
Significance:
Pressure ulcers increase pain and suffering, length of stay and health care costs, which are estimated at 11 billion annually (IHI 5 Million Lives Campaign). They can lead to other serious conditions such as cellulitis, osteomyelitis, sepsis and death.
Strategy and Implementation:
VA has utilized EHR since 1997. In 2003, VA Nursing Outcomes Data Base (VANOD) created health factors to track PU information such as Braden Score, PU stages and interventions. In 2009, daily Braden scores with presence and stage of PUs were transmitted to each VA Pittsburgh Med/Surg unit. A facility wide report of pressure ulcers is updated daily. Nurses plan interventions based on this timely information. When a HAPU occurs, nurses conduct a drilldown meeting to ascertain possible preventive interventions. The Wound Ostomy Continence Nurse (WOCN) discusses trends and comparisons with NDNQI data on each unit in a monthly Skin Briefing and plans for any new interventions. Interventions utilized include repositioning and heel offloading products, turning clocks, OOB for meals, improving supply availability, and a trial and implementation of protective foam dressing for sacral pressure ulcer prevention.
Evaluation:
WOCN sees all patients with PUs and validates VANOD and NDNQI data. HAPU incidence per 1000 bed days of care is calculated and shared with the Nursing Staff. Med/Surg HAPU incidence decreased by more than half from 2009 to 2010.
Implications for Practice:
EHR can be configured to produce nurse quality indicator data in real time. By utilizing this data to improve communication with front line nurses, interventions to improve specific issues can be formulated and used to decrease HAPU.