A Quality Improvement Project: Use of Clinical Decision Support (CDS) Tool in Improving Accuracy of Pressure Injury Assessment and Documentation in a Long Term Acute Care Hospital (LTACH)

Purpose: To evaluate the use of an algorithm in the assessment and documentation of pressure injuries in an LTACH setting through a Clinical Decision Support (CDS) tool.

Background: Pressure injury (PI) rates were rising above the national benchmarks over the past 3 years, 5.57% for year 2014, 2.70% for year 2015, and 3.42% for year 2016. The PI rates have been above the regional and national LTRAX benchmark rates. LTRAX is a combined data collection tool and outcomes engine built specifically for LTACHs. During chart audits, it was discovered that numerous wounds were inaccurately charted as new or worsening PI, incorrect identification of moisture associated skin damage as PI, and inaccurate staging of PI that resulted to higher prevalence PI rates.

Methods: The CDS tool is an algorithm based on the National Pressure Ulcer Advisory Panel’s PI definitions. The CDS tool is a 2 paged paper based algorithm with description of different stages with corresponding photographs for each PI. The second page included wounds that are not related to PI with descriptions and photographs. Prior to the introduction of CDS tool, nurses were asked to stage PIs with photos and descriptions. Data showed that only 36% of nurses were able to correctly stage PIs. CDS tool has been utilized by the same nurses for staging PIs, and data showed that 88% of the nurses correctly staged the PIs with the aid of the CDS tool.

 

Results: The use of the CDS tool has led to improvement in accurately staging PIs. PI rate for 2017 is improved with 1.0% which has been below regional and national rates when benchmarked against LTRAX and below facility’s goal of 1.5%.

 

Conclusion: Using an algorithm is effective in assisting nurses with their clinical judgement skills that led to a decrease in pressure injury rates.