Cath Lab Digest

Login to Download
PDF version

Index: Ostomy Wound Manage. 2012;58(3):46–51.

Abstract

  The integration of information technology into daily patient care potentially provides a means to standardize care and enable continuous quality improvement through improved communication among care teams. A 2-month observational study was conducted on 38 residents with pressure ulcers at a 51-bed skilled nursing facility to rate the Ease of Use and Wound Management Effectiveness of a point-of-care electronic wound documentation system. Nine nurses evaluated the use of handheld “smart phone” devices equipped with a digital camera to document pressure ulcer assessment and treatment at point of care. Ease of Use (five items) was scored on a 5-point Likert scale (5 = very easy); Wound Management Effectiveness (eight items) was scored on a 5-point Likert scale (5 = very effective).

  Statistically significant mean changes in nurses’ ratings were found for baseline compared to 2-month follow-up by paired t-test. Ease of Use ratings across the five criteria increased from an overall mean of 3.3 at baseline to 4.7 at follow-up (P = 0.5), while Wound Management Effectiveness increased from an overall mean of 3.3 at baseline to 4.4 at follow-up (P = 0.5) . The greatest gains for single items were reviewing wound progress (mean difference = 2.35; P = 0.000) and recognizing changes in wound status (mean difference = 1.78; P = 0.001) within the Ease of Use and Wound Management Effectiveness scales, respectively. The smallest change occurred in reading charts and notes (mean difference = 0.89) and ability to determine resident’s risk level (mean difference = 0.39). Further research is needed to assess use of a wound documentation system in this and other settings, as well as to ascertain validity and reliability.

Keywords: electronic wound documentation, mobile device, mobile wound care application, point-of-care documentation, wound care management process

Potential Conflicts of Interest: Ms. Scheurich is an employee; Dr. Croghan and Dr. Sheridan own stock; and Ms. Kurtz is a consultant for Telemedicine Solutions, LLC. Telemedicine Solutions, LLC provided an editing grant to Ms. Kurtz and Dr. McClain and a statistical analysis grant to Dr. McGill.

Literature Review

  The annual prevalence of persons with a pressure ulcer in the United States has been estimated at approximately 2.5 million.¹ Using an observational, cross-sectional cohort design, VanGilder et al,² reporting the results of the International Pressure Ulcer Prevalence Survey in the United States in 2008 and 2009, indicated overall prevalence and facility-acquired pressure ulcer rates of 13.5% and 6% (2008, N = 90,398) and 12.3 and 5% (2009, N = 92,408), respectively; in both study years, overall prevalence rates were highest in long-term acute care (22%) settings.

  Chronic pressure ulcers affect patient quality of life and are costly for both the facility and the overall healthcare system.³ Long-term care providers encounter numerous challenges, ranging from documentation requirements to the provision of proper pressure ulcer care. Preventing and treating wounds, including managing chronic wounds that do not heal or heal slowly, are challenging, even for nurses with specialty training in pressure ulcer care.⁴

  Evidence-based nursing is standard practice in healthcare.^5,6 Yet despite the availability of evidence-based guidelines, the gap between research and clinical practice remains.^7,8 Specifically, results of a retrospective, noncomparative interventional case series⁹ (n = 400) suggest that staff members in long-term care may not always adhere to published guidelines on wound documentation or treatment of chronic wounds.