Cath Lab Digest

P ressure ulcers are present in 1.6 million patients in the acute care setting.¹ The estimated average cost to manage a pressure ulcer is $37,000, which includes additional nursing time, supplies for dressings, medications, nutritional services, and physician fees.¹ Patients who develop pressure ulcers in the hospital usually have increased length of stay, increased cost, and pain.¹ Nurses need to accurately document the presence of a pressure ulcer and its characteristics to effectively provide patient care. Without the pressure ulcer documentation, a hospital may be found negligent if litigation is pursued.² Beitz, Fey, and O’Brien² found that many nurses need continued staff development to better assess and document wounds and pressure ulcers. With computer-based learning, staff educators and nurses can “click it and fix it” to provide education for an unlimited number nurses at any given time in the day.

According to Cooper,³ all wounds must be accurately assessed and documented to provide a baseline for recommended treatment and evaluation. Cooper also notes that without adequate documentation, healthcare providers cannot determine the effectiveness of treatments provided. Documentation for wound assessment should include location and size of the wound, presence of undermining or tunneling, condition of the wound bed, amount of exudate, presence of odor, and periwound condition.⁴

Deficits in documentation for pressure ulcers were identified by the Moses Cone Health System 2001 Prevalence Study.⁵ The data for two system hospitals reflected only three nursing units with complete documentation of pressure ulcers; the remaining 16 nursing units had inadequate or no documentation for pressure ulcers.

Moses Cone Health System consists of three acute care hospitals, one women’s hospital, one behavioral health hospital, and three long-term care facilities located in two counties. The challenge was to provide education to all nurses across the system in a timely manner without drastically disrupting patient care. A computer-based learning (CBL) module on identifying and documenting wounds called “Identifying Pressure Ulcers and Wounds” provided a potential solution.

Computer-based learning allows the participant to complete information at his/her own pace without the assistance of an instructor. This instructional method can provide graphics and illustrations for the visual learner — images that may later be recalled in clinical practice.⁶ Nurses can obtain knowledge, complete mandatory competencies, and enhance professional development by completing CBLs.⁷ Computer-based learning also can cut cost by allowing the learning modules to be completed on any nursing department during downtime.

Other advantages associated with CBL include 24-hour/day accessibility, self-paced learning, time savings, and consistent presentation of content.⁸ Computer-based learning is also beneficial because the evaluations can be automated and content can be revised quickly.⁹

Disadvantages associated with CBL are cost for the software, learner anxiety related to computer use, and the impersonal method of learning.¹⁰ Additionally, some nurses felt it was difficult to obtain timely answers to questions as they related to the content in the CBL.