By using clinical decision support (CDS) tools in conjunction with electronic health records, several dozen nursing homes across the country have reduced pressure ulcer incidence rates by 42 to 55 percent, according to a report from the California Healthcare Foundation. Their experience holds promise, not only for other nursing homes, but also for hospitals dealing with this all-too-common condition--one of the "never events" for which Medicare won't pay.
Following nursing home pilots that began in 2003, long-term-care IT vendors in 2008 developed a set of functional specifications to support software development of CDS reports. More than 75 nursing homes in the U.S. now have implemented a standardized CDS tool known as On-Time Pressure Ulcers, part of a program called On-Time Quality Improvement specifically designed for nursing homes.
Long-term-care facilities are looking at using similar solutions to prevent falls and avoidable transfers of residents to hospitals and emergency departments. Meanwhile, 10 long-term-care IT vendors have integrated On-Time requirements into their applications.
The basic premise of the On-Time program is that for clinicians in nursing homes to take full advantage of EHRs, they must understand how these systems can improve the quality of care. The On-Time approach is to integrate EHR documentation with CDS to achieve specific quality goals. Studies of the program have shown that "high-risk residents were identified earlier and more consistently, and that this affected clinical processes and staff experiences," according to the CHCF report.
To reduce the incidence of pressure ulcers, multidisciplinary teams used CDS reports that tracked the risk factors of patients, and they established practices for proactive risk identification and early intervention. Specifically, the reports identified residents with known risk factors for pressure ulcers such as poor nutrition, weight, urinary incontinence, bowel incontinence, and Foley catheter use. Then, the teams intervened to make sure the residents received appropriate follow-up, including tests, referrals, or changes in treatment plans.