Pressure Ulcer Case Study* A PBF study involving 95 long-term care facilities in
ID: 122897 • Letter: P
Question
Pressure Ulcer Case Study* A PBF study involving 95 long-term care facilities in the United States determined that nursing and clinical nursing assistant (CNA) interventions for pressure ulcer (PrU) prevention and management were highly variable among facilities and that nearly 30% of patients at risk for developing a PrU developed an ulcer during the 12-week study. Characteristics and interventions associated with higher and lower likelihood of PrU development are summarized in the table below. Research findings were used to develop PrU prevention protocols that included standardized CNA documentation of important data dements and CDS tools. Four long-term case facilities that participated in the study and shared a common electronic medical record system (all members of the same provider network) took the first step in changing practice by sharing study findings with clinical staff including CNAs, who spend the most one on-one treatment time with nursing home residents and thus are often the first members of the care team to observe changes in residents' nutritional intake, urinary incontinence, mood state, etc. Concurrently, local study leaders worked with their software vendor to incorporate standard documentation for nurses and CSAs and the CDS tools for staff. Negative Association with Likelihood of Developing a PrU (less likely) Patient factors Patient new to long-term care Treatment factors Use of disposable briefs for urinary incontinence for > 14 days Nutrition Use of oral medical nutritional supplements for > 21 days Tube feeding for > 21 days IV fluid supplementation Medications Antidepressant medication Facility staffing patterns RN hours greaterthanorequalto 0.5 hours/resident/day CNA hours greaterthanorequalto 2.25 hours/resident/day LPN turnover rateExplanation / Answer
1. The steps of the PBE precess related to this case study are determind by the
(a) Negative association with likelihood of developing a PrU.
(b) Positive association with likelihood of developing a PrU.
In this context paitent factors, treatment factors, nutrition factors , medication factors are indentified as useful evedences.
2. (a )Elements to be incorporate into documentation by CNAs and managers are nutritionery intake, urinary incontenence, and mood state.
(b) CDS tools that could be incorporate into computer systems local study leaders worked with their softwere vendor to incorporate standered documentation for nurse .
3. Research findings were use to develop PrU prevention protocols that included standerdized CNA documentation of importent data elements and CDs tools .