Increasing Documentation of Patient/Family Pressure Ulcer Prevention Teaching with the Availability of Electronic Educational Materials

Purpose:  The purpose of this study was to determine if the availability of written material on the intranet would increase nursing documentation of patient/family education regarding the prevention of pressure ulcerations (PU).

Background: NDNQI identified PU as a nurse-sensitive quality indicator. Direct care effort and patient teaching are dual strategies to reduce PU during hospitalization and after discharge. Therefore, documentation of patient/family education of PU prevention is essential. The Electronic Medical Record (EMR) is a unique environment in which educational material can be accessed and outcomes documented.

Methods:  Chart audits were conducted for a convenience sample of high PU risk (Braden Scale ≤18) patients pre-intervention. Ten patient charts from each critical care, step-down, and medical surgical units in a 550 bed, tertiary care, Magnet hospital were reviewed. A data collection tool was developed to identify if patient/family PU education was documented. A two pronged intervention began for all nurses. Patient/family educational material was created and placed on the facility’s intranet site. A Best Practice Alert was developed within the EMR alerting nurses to educate and document PU prevention for at risk patients. The nurses were prompted on what to teach and provided a link to the intranet educational material. After house-wide training on the PU program was completed, a post-intervention chart review was conducted.

Results:  In the pre-intervention review only 8.6% (15/130) had documentation of patient/family PU education, but this increased to 48.5% after the intervention. Units were classified as ICU, telemetry, or medical-surgical. All categories demonstrated statistically significant improvement in documentation.

Discussion:  Patient/family PU education can be improved by creative approaches. Developing and posting PU education online provides easily accessible material to print for patients. Using the Braden Score in the EMR to identify high risk PU patients and providing a nursing prompt, increases documentation of teaching.