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Pressure Injury Documentation Practices in the Department of Veteran Affairs

A Quality Improvement Project

Chavez, Margeaux A.; Duffy, Allyson; Rugs, Deborah; Cowan, Linda; Davis, Avaretta; Morgan, Storm; Powell-Cope, Gail

Journal of Wound Ostomy & Continence Nursing: January/February 2019 - Volume 46 - Issue 1 - p 18–24
doi: 10.1097/WON.0000000000000492
Wound Care
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Evidence suggests that inaccurate and incomplete pressure injury (PI) documentation threatens the validity of treatment and undermines policy and quality improvement. This quality improvement project sought to identify barriers and facilitators when conducting and documenting the daily comprehensive skin assessment in 31 Department of Veterans Affairs (VA) facilities. Evaluators in this 1-year, cross-sectional quality improvement project, using a qualitative approach, interviewed nurses of medical-surgical and critical care units. Participants (N = 62) from 12 high reassessment units (HRUs) and 13 low reassessment units (LRUs) were interviewed using telephone focus groups. Staff from HRUs reported 9 activities that ensured consistency in clinical practices, in validating data, and in correcting inaccuracies. The LRU staff tended to report performing only 2 of the 9 activities. The main barriers to accurate documentation were lack of knowledge, poor templates, and staffing issues such as understaffing and turnover, and main facilitators were an internal data validation process and a documentation template to local practices. Findings from this project led to increased VA leadership engagement, development of 3 innovative, award-winning VA mobile PI prevention and management applications, updated policies and directives on PI prevention, and upgrading of the national VA HAPI workgroup to an advisory committee and improved collaboration between the PI advisory committee and nursing informatics.

Margeaux A. Chavez, MPH, CPH, Nursing Innovations Center for Evaluation (NICE) and Center of Innovation of Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service, Veterans Health Administration, Tampa, Florida.

Allyson Duffy, PhD, RN, College of Nursing, University of South Florida, Tampa.

Deborah Rugs, PhD, Nursing Innovations Center for Evaluation (NICE) and Center of Innovation of Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service, Veterans Health Administration, Tampa, Florida.

Linda Cowan, PhD, ARNP, CWS, Nursing Innovations Center for Evaluation (NICE) and Center of Innovation of Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service, Veterans Health Administration, Tampa, Florida.

Avaretta Davis, DNP, MS, MHS, RN-BC, Office of Nursing Informatics, Veterans Health Administration, Washington, District of Columbia.

Storm Morgan, MSN, MBA, RN, Office of Nursing Services, Veterans Health Administration, Washington, District of Columbia.

Gail Powell-Cope, PhD, ARNP, FAAN, Nursing Innovations Center for Evaluation (NICE) and Center of Innovation of Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service, Veterans Health Administration, and College of Nursing, University of South Florida, Tampa.

Correspondence: Deborah Rugs, PhD, James A. Haley Veterans' Hospital, 8900 Grand Oak Cir, Tampa, FL 33637 (Deborah.Rugs@va.gov).

The authors have no conflicts of interest to declare. This material is based upon work supported by the Partnered Evaluation Initiative #PEI 13-430, a Quality Enhancement Research Initiative of the Office of Nursing Services and Office of Research and Development from the United States Department of Veterans Affairs.

Disclaimer: The contents do not represent the views of the Department of Veterans Affairs or the US Government.

© 2019 by the Wound, Ostomy and Continence Nurses Society.