“Measurement Monday”: One Facility’s Approach to Standardizing Skin Impairment Documentation
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In October 2007, the initiative was benchmarked against the literature to determine whether these efforts were consistent with the best evidence available.
Average daily census at the facility over the course of the study was 175 to 180. Although the frequency of various wound etiologies was not recorded (the main focus of the reviews was on the presence and quality of wound assessment/measurement documentation), the overwhelming majority of the wounds reviewed were pressure ulcers. Other types of wounds included skin tears, open surgical wounds, and diabetic and venous stasis ulcers. On initial (baseline) chart review in late 2005, 32 out of 54 reviewed charts (59.3%) did not contain documentation of wound size measurements. Following initial education efforts and implementation of Measurement Monday in early 2006, chart reviews conducted from April through June 2006 showed that 38.5% of charts lacked wound size measurement documentation, a decrease of almost 21%. After implementing The Weekly Measurement Graph/Impaired Skin Integrity Tool in January 2007 and re-emphasizing prior education, follow-up chart reviews in February through August 2007 indicated further documentation improvements, with only 14.8% of charts lacking wound size measurement information (see Table 1).
In addition to the improvement in chart audits, many nurses verbalized their satisfaction with the designated measurement day and The Weekly Measurement Graph/Impaired Skin Integrity Tool. The new form and processes allowed nursing staff to monitor wound progress more easily and saved nursing time when documenting. At every chart review point, the proportion of wound measurements recorded by the nurses, as opposed to the WOCN, increased.
No literature as yet exists to support use of a designated day of the week as a mnemonic for consistent wound assessment. The Measurement Monday process was found to help nurses be more consistent and efficient; anyone with a skin impairment is measured on Monday. This approach helped eliminate confusion regarding which patients needed to have skin/wound measurements completed.
The purpose of the Keast5 mnemonic was to provide nurses with a framework to recall what characteristics must be assessed in the management of chronic wounds. Although the Measurement Monday mnemonic did not provide such a system, The Weekly Measurement Graph/Impaired Skin Integrity Tool provided assessment prompts.
Current literature recommends the use of a consistent measurement technique. The Measurement Monday project did not endorse the use of any particular measurement tool, but the provision of rulers and documentation tool allowed for consistent documentation of linear measurement data. Langemo et al11 and Plassman et al18 support regular wound assessment, which includes the use of consistent measurement practices.
Approximately 6 months after the last chart audits, the authors’ facility transitioned to an electronic medical record (EMR). The weekly measurement tool was incorporated into the flowsheet documentation section of the new record. Although the appearance of the document changed, the same consistent assessment/measurement fields are available and a field to document wound exudate was added. No significant change in documentation compliance has been noted once staff became accustomed to the new EMR.
Implications for Practice and Research
Facilities facing the challenge of wound documentation might want to consider designating a specific day of the week for wound assessments and measurements.
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