Standardized quality-assessment system to evaluate pressure XXXX care in the nursing home.

@entity1 @entity1066 @entity5155
OBJECTIVES: To demonstrate reliability and feasibility of a standardized protocol to assess and score quality indicators relevant to pressure @entity1066 (PU) care processes in nursing homes (NHs). DESIGN: Descriptive. SETTING: Eight NHs. @entity1 : One hundred ninety-one @entity5155 residents for whom the PU Resident Assessment Protocol of the Minimum Data Set was initiated. MEASUREMENTS: Nine quality indicators (two related to screening and prevention of PU, two focused on assessment, and five addressing management) were scored using medical record data, direct @entity1 observation, and wireless thigh monitor observation data. Feasibility and reliability of medical record, observation, and thigh monitor protocols were determined. RESULTS: The percentage of @entity1 who passed each of the indicators, indicating care consistent with practice guidelines, ranged from 0% to 98% across all indicators. In general, @entity1 in NHs passed fewer indicators and had more problems with medical record accuracy before a PU was detected (screening/prevention indicators) than they did once an @entity1066 was documented (assessment and management indicators). Reliability of the medical record protocol showed kappa statistics ranging from 0.689 to 1.00 and percentage agreement from 80% to 100%. Direct observation protocols yielded kappa statistics of 0.979 and 0.928. Thigh monitor protocols showed kappa statistics ranging from 0.609 to 0.842. Training was variable, with the observation protocol requiring 1 to 2 hours, medical records requiring joint review of 20 charts with average time to complete the review of 20 minutes, and the thigh monitor data requiring 1 week for training in data preparation and interpretation. CONCLUSION: The standardized quality assessment system generated scores for nine PU quality indicators with good reliability and provided explicit scoring rules that permit reproducible conclusions about PU care. The focus of the indicators on care processes that are under the control of @entity5155 staff made the protocol useful for external survey and internal quality improvement purposes, and the thigh monitor observational technology provided a method for monitoring repositioning care processes that were otherwise difficult to monitor and manage.
