Enhancing Documentation of Pressure Ulcer Prevention Interventions

Jacobson, Therese; Thompson, Susan; Halvorson, Anna M.; Zeitler, Kristine

doi:10.1097/ncq.0000000000000175

Cited by 11 publications

(11 citation statements)

References 5 publications

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“…Thus, to some extent, some of the lower levels of implementation that were found may rather be a reflection of inadequate documentation. In nursing practice, documentation is key to the record of actual care delivery and incomplete documentation can increase costs if a PI is deemed hospital-acquired and hospitals are charged a financial penalty (Jacobson, Thompson, Halvorson, & Zeitler, 2016). Implementation documentation should be clearly separated from prescription (Lovegrove et al, 2018a).…”

Section: Intervention Implementationmentioning

confidence: 99%

Relationship Between Prescription and Documentation of Pressure Injury Prevention Interventions and Their Implementation: An Exploratory, Descriptive Study

Lovegrove

Fulbrook

Miles

2020

Worldviews Ev Based Nurs

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Background: Formal assessment by nurses of a patient's pressure injury (PI) risk level is often highlighted as being key to PI prevention. However, if no action is taken to address the determined risk (i.e., if appropriate preventative interventions are not implemented), the patient remains vulnerable to PI development, and the assessment process is rendered pointless. Aim: To explore the relationship between the prescription (planning) and implementation of PI preventative interventions by nurses following formal risk assessment. Methods: Using an exploratory, descriptive design, the charts and bedside areas of 200 adult patients admitted across four hospital wards were examined. Data collected included PI risk level, documented prescribed preventative interventions, and interventions for which there was evidence of implementation. Results: Of the final sample (n = 187), 66.8% of cases were categorized as being "at-risk" or above. As the risk category of patients increased, proportionately more patients in each category were prescribed each intervention. However, in most cases, significantly fewer interventions were actually implemented than were prescribed, except for several interventions that were implemented in more cases than were prescribed. There were 14 cases, including four at-risk and three high-risk patients, in which no preventative interventions were prescribed, while 88.7% of not at-risk patients had (unnecessary) preventative interventions prescribed. Discussion: These results indicate that intervention prescription increased relative to assessed level of risk; however, the rates of intervention prescription and actual implementation were suboptimal. The results indicate a significant mismatch between these two steps of PI prevention. Linking evidence to action: These results indicate that intervention prescription increased relative to assessed level of risk; however, the rates of intervention prescription and actual implementation were suboptimal. A significant mismatch between these two steps of PI prevention was evident. Following patient risk assessment, there should be a greater focus on appropriate preventative intervention prescription (planning) with regular review and audit to help ensure that interventions are implemented as prescribed. Improved implementation of preventative interventions should, in turn, help to reduce hospital-acquired pressure injuries. BACKGROUND International consensus is that hospital-acquired pressure injury (PI) is predominantly preventable with the provision of appropriate preventative care (Edsberg, Langemo, Baharestani, Posthauer, & Goldberg, 2014). Having a PI is painful, and thus, it negatively affects a person's quality of life (Jackson et al., 2017), increases hospital length of stay, and increases the costs of health care (Nguyen, Chaboyer, & Whitty, 2015). The development of a PI, also known as pressure ulcer, is therefore considered to be an indicator of the quality of care, particularly the nursing care, provided to hospital inpatients (Kottner, Hahn...

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Section: Intervention Implementationmentioning

confidence: 99%

Relationship Between Prescription and Documentation of Pressure Injury Prevention Interventions and Their Implementation: An Exploratory, Descriptive Study

Lovegrove

Fulbrook

Miles

2020

Worldviews Ev Based Nurs

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“…Twenty two studies had audit and feedback as one of the strategies used to improve compliance with nursing documentation ( Azzolini et al, 2019 ; Bernick & Richards, 1994 ; Cline, 2016 ; Elliott, 2018 ; Ellis et al, 2007 ; Esper & Walker, 2015 ; Gerdtz et al, 2013 ; Gloger et al, 2020 ; Gordon et al, 2008 ; Goulding et al, 2015 ; Hayter & Schaper, 2015 ; Hom et al, 2019 ; Jacobson et al, 2016 ; Kamath et al, 2011 ; Okoyo Nyakiba et al, 2014 ; O’Connor et al., 2014 ; Porter, 1990 ; Stocki et al, 2018 ; Tejedor et al., 2013 ; Trad et al., 2019 ; Unaka et al., 2017 ; Wissman et al, 2020 ). Sixteen of these studies had a final compliance rate ≥ 70%.…”

Section: Resultsmentioning

confidence: 99%

“…When audit and feedback are combined with the use of a pre-existing EHR the results are also encouraging ( Cline, 2016 ; Elliott, 2018 ; Esper & Walker, 2015 ; Gerdtz et al, 2013 ; Gloger et al, 2020 ; Hayter & Schaper, 2015 ; Hom et al, 2019 ; Jacobson et al, 2016 ; Kamath et al, 2011 ; Tejedor et al, 2013 ; Unaka et al, 2017 ). Ten of the 11 studies had a final compliance rate ≥ 70%.…”

Section: Resultsmentioning

confidence: 99%

Strategies to Improve Compliance with Clinical Nursing Documentation Guidelines in the Acute Hospital Setting: A Systematic Review and Analysis

Bunting¹,

Klerk²

2022

SAGE Open Nursing

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Introduction This systematic review attempts to answer the following question – which strategies to improve clinical nursing documentation have been most effective in the acute hospital setting? Methods A keyword search for relevant studies was conducted in CINAHL and Medline in May 2019 and October 2020. Studies were appraised using the Joanna Briggs Institute (JBI) critical appraisal for quasi-experimental studies. The studies were graded for level of evidence according to GRADE principles. The data collected in each study were added to a Summary of Data (SOD) spreadsheet. Pre intervention and a post intervention percentage compliance scores were calculated for each study where possible i.e. (mean score/possible total score) × (100/1). A percentage change in compliance for each study was calculated by subtracting the pre intervention score from the post intervention score. The change in compliance score and the post intervention compliance score were both added to the SOD and used as a basis for comparison between the studies. Each study was analyzed thematically in terms of the intervention strategies used. Compliance rates and the interventions used were compared to determine if any strategies were effective in achieving a meaningful improvement in compliance. Results Seventy six full text articles were reviewed for this systematic review. Fifty seven of the studies were before and after studies and 66 were conducted in western countries. Publishing dates for the studies ranged from 1991 to 2020. Eleven studies included documentation audits with personal feedback as one of the strategies used to improve nursing documentation. Ten of these studies achieved a post intervention compliance rate ≥ 70%. Conclusion Notwithstanding the limitations of this study, it may be that documentation audit with personal feedback, when combined with other context specific strategies, is a reliable method for gaining meaningful improvements in clinical nursing documentation. The level of evidence is very low and further research is required.

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Section: Discussionmentioning

confidence: 99%

“…Proper documentation of patient assessment and nursing care aids the exchange of information between disciplines 17 and provides a means to demonstrate evidence of unavoidable negative outcomes when all best practices were conducted. 20,21 At the completion of the project, documentation of patients' aspiration risk factors on admission increased by 40% (Figure 3) with a 51.3% increase of MBSS swallow screening results (Figure 4). Even though methods for improving nursing documentation has been the topic of past research and QI projects, there is not one single strategy that has been proven to be most effective in the acute care setting.…”

Section: Discussionmentioning

confidence: 99%

Use of PDSA Cycles to Increase Aspiration Risk and Swallow Screening Documentation in the Hospitalized General Medical Patient Care Population

Jaekel

Becker²,

Voss³

2022

Journal of Nursing Care Quality

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Background: Aspiration, while hospitalized, can lead to increases in length of stay and health care costs. Nurses must identify patients at risk of aspiration early to initiate appropriate precautions. Local Problem: An increase in-hospital patient aspirations at a Midwestern hospital prompted a review of events, which identified opportunities to improve identification of patients' risk factors and completion of the bedside swallow screening. Methods: Interventions were identified via a causal factor tree analysis and an impact-effort grid then deployed using the Plan-Do-Study-Act (PDSA) methodology. Interventions: Interventions deployed included game based-learning, a unit-based champion, and the use of visual cues to identify patients at risk for aspiration. Results: After 3 PDSA cycles, documentation of patients' aspiration risk factors on admission increased by 40%, with a 51.3% increase in bedside swallow screening results. Conclusion: Iterative PDSA cycles successfully tested staff engagement strategies to improve aspiration risk and swallow screening documentation compliance.

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Enhancing Documentation of Pressure Ulcer Prevention Interventions

Cited by 11 publications

References 5 publications

Relationship Between Prescription and Documentation of Pressure Injury Prevention Interventions and Their Implementation: An Exploratory, Descriptive Study

Relationship Between Prescription and Documentation of Pressure Injury Prevention Interventions and Their Implementation: An Exploratory, Descriptive Study

Strategies to Improve Compliance with Clinical Nursing Documentation Guidelines in the Acute Hospital Setting: A Systematic Review and Analysis

Use of PDSA Cycles to Increase Aspiration Risk and Swallow Screening Documentation in the Hospitalized General Medical Patient Care Population

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