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Improving Processes to Capture Present-on-Admission Pressure Ulcers

Rogers, Catherine DNP, APRN-BC, CWCN, CWS

doi: 10.1097/01.ASW.0000437949.62301.6e
Features: Clinical Management Extra

PURPOSE: To enhance the learner’s competence with information geared toward improving processes to capture present-on-admission pressure ulcers.

TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

OBJECTIVES: After participating in this educational activity, the participant should be better able to:

1. Analyze the research study presented and its effects regarding identification of present-on-admission pressure ulcers (PrUs) and reduction of healthcare-acquired conditions.

2. Identify implications of proper admission skin assessment and documentation on reimbursement by the Centers for Medicare & Medicaid Services.

3. Implement recommendations from the research study for ways to improve PrU documentation on admission assessment.

ABSTRACT OBJECTIVE:This study was designed to determine if a process could be built to accurately capture present-on-admission (POA) pressure ulcers (PrUs). Will a formalized electronic process designed to identify, communicate, and document assessment findings of POA PrUs from clinical nurses to admitting physicians reduce missed identification of POA PrUs, improve communication processes, improve physicians’ documentation, and improve reimbursement for the hospital?

DESIGN: A before-and-after study design in a single site over a 4-month period compared with the same period during the previous 2 years.

SETTING: An acute-care, 333-bed hospital in the Midwestern United States.


Nurses were the primary study population.

INTERVENTION: The wound assessment screen in the electronic medical record (EMR) was revised to include a new prompt for POA documentation and communication to the admitting physician of the assessment findings.

MAIN OUTCOME MEASURES: An increase in POA PrU reporting and reduction in hospital-acquired condition (HAC) reported PrUs.

RESULTS: A statistically significant change (2010: P < .01, z = 2.507; 2011: P < .01, z = 2.632) was found for POA; HAC also had a statistically significant change (2010: P = .02, z = 2.411; 2011: P < .01, z = 2.781).

CONCLUSIONS: The implementation of the electronic prompt did not contribute to the improvement in the POA and HAC rates because the reduction occurred before the EMR prompt intervention. Changing processes such as EMR upgrades, shared governance, Magnet journey, participation in the National Database of Nursing Quality Indicators, and unit-based nursing councils and skin care champions may have exerted positive forces and contributed to improvement in the communication process between the admitting physicians and the clinical nurses.

This continuing education activity discusses whether a process could be built to accurately capture present-on-admission pressure ulcers.

Catherine Rogers, DNP, APRN-BC, CWCN, CWS • Advance Practice Nurse • Swedish American Health System • Rockford, Illinois

Acknowledgments: The author thanks Project Defense Committee Members Patricia R. Lewis, PhD, RN; Valerie Gruss, PhD, RN, CNP-BC; and Ann Gantzer, PhD, RN, NEC-BC, for their guidance.

The author, faculty, and planners, including spouses/partners (if any), in any position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least 13 of the 18 questions correctly.

This continuing educational activity will expire for physicians on December 31, 2014.

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