The document discusses an organization's efforts to improve pressure ulcer prevention through innovative electronic solutions. They added checkboxes and automatic notifications to their electronic documentation system to better identify patients at risk of pressure ulcers, even if their Braden scale scores indicate low risk. This helps notify dietitians, physical therapists, and wound care nurses to screen patients. Daily monitoring of supplements and nutritional plans are also documented electronically. The system aims to prevent missed identification of at-risk patients and improve communication between departments.

2. P ressure U lcer P revention P lus I nventive E lectronic S olutions

6. We found that paper just isn’t enough. We need our electronic systems to help catch those patients that don’t fit the “at risk” pressure ulcer criteria outlined when utilizing the standard braden scale.

7. We may admit a patient with a pressure ulcer present upon admission to the hospital. The Braden Scale score can indicate that the patient is at minimal risk of skin breakdown, even though their skin has already broken down! That just doesn’t seem to make sense. We tweaked our parameters. We still use the conventional braden scale but we added additional features to assist us. Now those at risk patients don’t fall between the cracks.

14. 12

16. If this nutritional screen indicates that the patient may possibly be at a nutritional risk, the Dietician then completes an initial assessment. If the last check box/boxes are checked, an electronic automatic message will be sent notifying the Dietician to see this patient.

19. Daily concurrent monitoring of dietary supplements occurs when entered electronically on the flowcharts and will automatically be calculated into the Intake and Output totals and graphic I&O. Supplements and nutritional / hydration plans are entered onto an electronic record by the Dietician. This information will automatically copy forward to a discharge communication tool regarding pressure ulcers to enhance communication with post discharge facilities

22. Our cardiopulmonary department performs a pressure ulcer assessment, documentation and even interventions involving their oxygen delivery equipment. They document this on an electronic form. An electronic notification is then automatically generated to the nursing supervisors and to the wound care nurse for follow up.

31. It’s difficult to stage an ulcer correctly on admission. We are developing a plan that will assist in auto-scoring the correct pressure ulcer stage and then prevent the nurse from later entering an incorrect stage level. We created a flowchart that calculates the stage based upon the description of the ulcer, and our trials were successful! We need to test further then implement in the near future. Example: Remember once an ulcer is staged, it can not be documented as a lower stage even after it’s healed. If it’s a stage 3 on admit, it’s a stage 3 or a healing stage 3. The ulcer may become worse but not a lower stage… We are trying to develop an electronic method that will not allow backstaging of ulcers once staged.

32. We will begin using the electronic acuity which the nursing supervisors will review alerting them regarding a change in a patient’s status. Ideally, the braden scale should be reassessed as the patient status changes. We will utilize our acuity tool to help us identify alterations in the level of care.

33. The PUPPIES team works closely to ensure all process measures are working effectively

34. Thank You!