Poster - #UCDH7 - Evidence-Based Practice, Quality Improvement, Innovation, Previously Presented Externally

Using Technology to Enhance Identification and Documentation of Pressure Ulcers/Injuries (PU/I): Present on Admission (POA) Project

Oleg Teleten, MS, RN, CWCN Larisa Kuzmenko, RN, WCC Stacy Hevener, MSN, RN, CSSGB, CPHQ, CCRN-k Holly Kirkland-Kyhn, PhD, FNP, CWCN
n/a

ABSTRACT
Background Many patients are admitted to the hospital with pressure ulcer/injuries (PU/I) that are present on admission (POA) not identified or staged. Stage 4 PU/I POA are reimbursed at a higher rate. Also, POA may be misclassified as a hospital acquired PU/I if not documented and staged on admission. Current workflows at this level 1 trauma center for PU/I POA required an Incident Report (IR) taking 15-17 minutes to complete by the bedside nurse, 15 minutes of quality nurse review, 15 minutes of unit manager review, and 15 minutes by the IR category manager review per IR. We receive over 2,000 IRs per year for PU/I POA. The IR data was not auditable, reliable or valid. Aims 1. To identify and stage all PU/I POA 2. To eliminate the current IR work flow required for PU/I POA 3. To use the EMR to create a new workflow for PU/I POA Methods We created a mandatory EMR field: “ Does this patient have a PU/I POA?” If “yes”, the link for: “Need help staging?” opens with definitions and images of PU/I for matching. The nurse then uses the Rover to take a photo which is embedded directly into the patients chart. Daily reports are created and matched with the photos to validate the stage and test inter-rater reliability. Results With the new workflow we increase identification of POA and staging from 5 to 60 weekly. We are able to track those patients, capture the coding for stage 4 PU/I, cut 2,000 hours/year of nursing time with more valid data. We now identify and track those multi-visit patients (MVP) (4 or more hospital admissions/year) and their characteristics. Conclusion- In conclusion, we have created a work flow within EMR that tracks, audits, and improves efficiencies in nursing care, communication, and documentation.