Use of Evidenced Based Practice and the Electronic Health Record (EHR) to Improve Clinical Outcome of Pressure Ulcers Across a System (Trinity Health)

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Use of Evidenced Based Practice and the Electronic Health Record (EHR) to Improve Clinical Outcome of Pressure Ulcers Across a System (Trinity Health)

Mary A. Gerlach, MSN, APRN-BC, CWOCN, Herny Ford Macomb Hospital, Clinical Nurse Specialist/WOCN, 15855 Nineteen Mile Road, Clinton Township, MI 48038 and Trinity Health Pressure Ulcer Workgroup, Trinity Health, multidisciplinary health care team, 27870 Cabot Drive, Novi, MI 48377-2920.

PURPOSE: Hospital–acquired pressure ulcers continue to be a major quality management issue in which the estimates of prevalence and costs remain substantial and under-reported. OBJECTIVE: A major initiative over the past year for Trinity Health, a multi-state hospital system, has been the reduction of facility acquired pressure ulcers to a level of one per cent thru the use of evidenced based practices and the (EHR). A twenty member, multidisciplinary team was formed across Trinity Health and convened for one face-to-face meeting for kick-off of the project. The remainder of the project was accomplished with monthly to bi-monthly phone conferences & Centra® computer sessions. OUTCOMES: Major changes as a result of this initiative have resulted in: (1) system-wide standardization of processes related to pressure ulcer risk assessment, documentation, and prevalence/incidence; (2) development and integration into the EHR, an “auto generated” nursing alert when the patient is identified at risk by the pressure ulcer risk screening criteria; (3) automatic attachment of an “at risk for skin integrity nursing problem” for patients at risk; and (4) development of an evidenced-based pressure ulcer prevention order set with embedded links to the literature. In the near future, digital pictures and definitions of the 2007 National Pressure Ulcer Advisory Panel (NPUAP) Pressure ulcer staging system will be added to the EHR to increase staff accuracy with assessment and documentation of existing pressure ulcers. DISCUSSION: These interventions were activated in the EHR August 2007. Initial data indicate that 51% of patients were identified to be at risk for developing a pressure ulcer. This poster will provide an overview of the project and share data related to processes and outcomes.

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