Using Technology to Improve Quality: A HAPU Project

Using Technology for Quality Improvement - A Hospital Acquired Pressure Ulcer (HAPU) Project

Purpose and/or Objectives

We have leveraged technology in the data collection for NDNQI and quality improvement projects surrounding pressure ulcer prevention, documentation, and education. The electronic medical record (EMR) has aided with data collection for the determination of the prevalence of hospital acquired pressure ulcers with the use of the EMR technology.

Background and Significance

Pressure ulcer prevalence and incidence rates are highest in those receiving palliative/ hospice care, spinal cord injuries, critical care and for long term care.

It is important to distinguish pressure ulcers that are present on admission from those pressure ulcers that have been hospital acquired. HAPU are a measure of nursing quality and are reportable to multiple sources in comparing quality and safety.

Early identification of individuals at risk and early interventions are essential for maintaining goals for prevention and management.

Methods

We established a process in the EMR, to have a best practice act (BPA) added to the EMR admission process in order to identify patients who were admitted with pressure ulcers. Before the BPA was instituted as a mandatory field, the data collected from this field showed 5-pressure ulcers/week-- present on admission. Once the mandatory BPA was instituted the reported pressure ulcers present on admission was 35-50 pressure ulcers/week. We reviewed the choices for documentation in the EMR and defined the information to be collected from EMR. The data collection points were set for computer extraction for every patient for the designated NDNQI data collection date. The set data collection points (documentation) were extracted: a) skin assessment, b) pressure ulcer risk assessment, c) risk assessment scale and scores, and d) all of the defined interventions that were documented according to set parameters.

Measurement tools and research data collection was  used to involve staff in siloed areas. Staff were involved in data collection and deciding new interventions. All measured data outcomes were shared with staff using photos and graphs.

Results/Outcomes

• Early identification of patients with pressure ulcers present on admission
• Efficient data collection (work hours and associated RN pay) as compared to manual abstraction of the data
• Data abstracted was more reliable and accurate
• We had immediate access to the outcome data
• We were able to perform “just-in-time” education to units to improve the documentation and quality of care

Conclusion

The measurement of the HAPU prevalence and incidence allows organizations to monitor patient outcomes for comparison over time and between institutions. Using the EMR for data collection (NDNQI, CalNOC surveys) enhances the reliability and accuracy of the measurement of the risk and the interventions associated with the prevention of pressure ulcers.