Improving Accuracy of Pressure Ulcer Staging and Documentation Using Innovative Computerized Decision Support

More than 2.5 million pressure ulcers (PU) occur in U.S. hospitals each year at a mean cost of $11 billion. The magnitude of the problem and the potentially devastating financial consequences due to reimbursement as of 2008, have provided many challenges for WOCNs in developing innovative approaches to improving outcomes. A needs assessment identified nurses’ continued difficulty with accurately staging PUs. An innovative approach focusing on staff education, accessible resources, and revision of the computerized documentation system was created to address the problem.

Purpose: The purpose of this practice innovation is to improve nurses’ accuracy of PU staging and documentation.

Objective: This  presentation will overview the multifaceted project that focused on the development and implementation of a computerized documentation system with decision support of PU staging and staff education.

The 2007 NPUAP revisions to staging were used to guide nurses’ education. Since this affects all nurses, experienced and novices alike, a user friendly system was conceived to facilitate both accurate staging while providing a venue for education. The nurse accesses a drop down menu of descriptors based on NPUAP definitions. After selecting appropriate skin/ulcer characteristics from mandatory screens, the computer suggests the stage. Education screens can be accessed from the same screen for further explanation. A summary of the process includes:

1. The nurse must assess and document location, depth, characteristics and color using a drop down menu.

2. The computer then suggests a PU stage which guides the nurse in correctly assigning the stage.

3. The nurse can document additional ulcer characteristics ie. tunneling, drainage, odor etc. from a drop down menu and radio buttons.

Outcomes:

The project is expected to improve the accuracy of PU staging and associated documentation by bedside nurses. Data is currently being collected that includes random paired audits of patient and associated documentation for accuracy, and compliance with documentation standards.