Electronic Health Record Innovations for Pressure Ulcer Prevention - Essay Example

? Electronic Health Record (EHR) for prevention and management of pressure ulcer Number Introduction Theimplementation of electronic health record (EHR) for prevention and management of pressure ulcer can be daunting, but it is worthwhile. EHR ensures a health facility easy access to and use of important data easily and faster during patient appointments. The program can provide effective assessment tools and management processes for pressure ulcer, which would be a dream in a paper-work system (Liang, 2007). Regardless of the size of the project, the proper integration of a skilled workforce, proven strategies and technology at MICU, would see the successful implementation of the program in various units for easy use by clinicians. If properly utilized, EHR can be the silver bullet to the problem of inconsistencies that are the order of the day in documenting pressure ulcer management processes through paper-work. Prevention of Pressure Ulcer According to Hagens and Krose (2009), to maximize the benefits the EHR for Pressure Ulcer prevention and management, it would be vital to keep problem lists, medical prescription lists and sensitivity lists in all units handling the patients s(National Pressure Ulcer Advisory Panel, 2007). In the MICU case, medical assistants or skin care specialists should enter medications and sensitivities from the paper work, and physicians would enter the problem lists. It would be appropriate to enter data shortly before an appointment is due, and take the chart to scanning. In doing so, the pressure ulcer management units will have an entirely electronic chart ready for patient handling when the patient arrives at the units (Kerr, 2009). Alternatively, it would be appropriate to enlist registered nurses for the task of problem list entry before the program is ready for use by various clinicians. Assessment for Pressure Ulcer For acute care, the first assessment should be carried out on admission and after every 1-2 days or whenever the condition of the patient changes (Clarke, Bradley, Whytock, Handfield, Van der Wal, & Gundry, 2005). At MICU, the system would be programmed to notify the health care providers to do assessments every 24 hours. For home health, the first assessment would be carried out on admission, and re-examination done as soon as the patient resumes care, during recertification, refer or release, or whenever the patient’s health condition changes (Adler, 2010). At MICU, it would be appropriate to reassess the patient’s condition at each nursing visit. And for long-term care in MICU, the initial screening for patients would be appropriately done on admission and every week during subsequent missions. Determining Risk Levels Several electronic tools for risk assessment are accessible to assist in predicting the level of risk of the disease (National Pressure Ulcer Advisory Panel, 2007). They include machines with values that when summed up together, can enable the health care providers to determine the risk score in totality. The Braden and Norton Scales are proven tools that can be used to provide an electronic data for predicting the risk of pressure ulcer risk in MICU. According to Ayello, Capitulo, Fife, Fowler, Krasner, Mulder, Sibbald, and Yankowsky (2009), these tools help clinicians to determine the risk values, which eventually can lead to the formulation of the most appropriate and opportune medical interventions. Norton Scale The Norton Scale comprises five groups: physical and mental conditions; mobility, activity, and incontinence. These factors are valued from 1– 4 (Tavenner, & Sebelius, 2012). The total values usually range from 5 to 20. An entry of the following data to the EHR system can help clinicians to cope with the condition in a more effective and faster way: Mild Risk values at 14: Moderate Risk at 13: and High Risk at 12. The scale should be credible and kept in such condition to avoid errors in the final readings of data (Liang, 2007). Any alterations can change or render it an ineffective tool for assessing patient risks of developing pressure ulcers in future. Braden Scale The Braden Scale is made up of half a dozen categories. These include; sensory perception, wetness, activity, movement, and nutrition (Tavenner, & Sebelius, 2012). The values are rated from 1 to 4. Friction is rated 1 to 3. The whole score therefore, will range from 6 to 23. Higher values means the patient is at low risk of developing pressure ulcers. The documentation of the following information in the EHR system would help clinicians to grapple with the condition faster and more efficiently: Mild Risk, 15–18; Moderate Risk, 13–14, High Risk, 10–12 and Very High Risk ? 9 (Ayello et al, 2009). It is advisable, though, that if the patient is at high risk of other health factors such as fever, poor nutrition, or low blood pressure, he or she should be screened further. Risk Factors Certain categories of patients have higher prevalence rates for developing pressure ulcers (National Pressure Ulcer Advisory Panel, 2007). These include the baby boomers and the octogenarians; patients with spinal cord injury, and those in intensive care units. Patients who have a broken hip or those who have stayed in care facilities for long periods of time are at a higher risk for pressure ulcers in their heels (Dahm, & Wadensten, 2008). Spasticity enhances the vulnerability for skin injury, as does the level of the paralysis in younger people who do not practice good skin care (Ayello et al, 2009). Delays in seeking medical interventions or failure to implement preventive measures can also increase the risks (Green, & Thomas, 2008). Patients admitted to intensive care units may develop pressure ulcers within three days of their admission to the facility. What to measure It would be appropriate for MICU to implement prevention programs for pressure ulcers by initiating automated and regular and routine patient assessments (Thielst, & Gardner, 2008). The assessments should be based on the patient’s skin. Factors that increase the prevalence rates of the disease in patients should also be managed in order to avoid the development of a pressure ulcer. Skin A thorough inspection of the patient’s skin from head to toe should be carried out whenever a patient is admitted to the hospital and at least every 24 hours (Ayello et al, 2009). At MICU it would be done on high-risk areas such as protruding body surfaces, using Norton Scale and Braden Scale and the readings entered into the system. Specifically, the clinicians should assess areas such as the occiput, heels, and sacrum among other areas if the victim is bed-ridden and the coccyx among other places deemed fit by the medical staff if, the victim is chair-bound (National Pressure Ulcer Advisory Panel, 2007). It would be appropriate for MICU to carry out a five-fold criterion for skin assessment: the measurement of skin temperature, skin texture, skin colour, skin integrity, and dampness status and the data updated on the system. If a Blanchable erythema is established, it is a probable symptom of a developing pressure ulcer (Ayello et al, 2009). The condition manifests in the form of a reddish area that temporarily changes to white or pale colour when it is pressed with a fingertip. The redness of a spot affected by Blanchable erythema means that body tissue around the area has already been damaged (National Pressure Ulcer Advisory Panel, 2007). Patients with dark skin can present challenges to clinicians, as the reddish colour may not be easily visible. Clarke et al (2005) suggest that the heath care provider would need to compare the specific area with skin adjacent to it and assess for variations in colour or temperature or if it is aching. An effective EHR should provide directions on how to handle the situation: for instance, it would provide solutions on the need to remove special clothes or gadgets such as tight, heel and elbow caps to allow for the assessment of the skin at least every 24 hours. Individuals wearing such devices are at higher risk of developing pressure ulcers. Immobility Lack of body movement is the most notable risk factor for the development of pressure ulcer. Patients who have a restricted degree of movement need more regular monitoring to avoid pressure ulcers (Ayello et al, 2009). Such patients include; the non-ambulatory; those who are bed-ridden or those confined to chairs, recliners, couches, and or wheelchairs for an extensive period of time. Additionally, patients grappling with paralysis or those wearing orthopaedic clothing that restrain their ability to move; and those who need assistance to move, change their position, or move out of their confinements, all need help to avoid developing pressure ulcers (Green, & Thomas, 2008). Friction Shearing is often caused by the physical force of surfaces moving against each other, and could cause damages such as blisters to the skin. Patients who must be helped to reposition themselves are at high risk of suffering skin frictions and injuries in the process of their transfer. Shearing is the physical force that acts against the skin and destroys big tissues like body muscle. Tissues supported by the bone are dragged in a given direction whereas tissues remain constant. In most cases, shearing takes place when the upper section of the bed is raised and the patient’s moves downward. An EHR guiding clinicians on patient handling is better than the use of paper-work or issuing verbal instructions Incontinence According to the National Pressure Ulcer Advisory Panel (2007), the dampness caused by incontinence can lead to the development of pressure ulcer. This wets the skin and raises the vulnerability of the part to injuries caused by friction. Faecal incontinence increases the risk of developing pressure ulcer more than urinary incontinence because the excrements contain disease causing micro-organisms and enzymes that can corrode the skin (Clarke et al, 2005). When an incontinence caused by both excretory factors occurs, the faecal enzymes transform transforms the urea in the urine into ammonia. This increases the alkalinity of the skin, and renders the skin more vulnerable to injury. MICU would be more careful in handling incontinence patients, because they such patients are three times more likely to develop pressure ulcers (Ayello et al, 2009). Nutritional Status Even though, particular foods and their specific impact on preventive measures for pressure ulcers are yet to be documented, malnutrition is linked to a general morbidity and higher chances of death (Ayello et al, 2009). A dietary assessment would be carried out on admission and every time there is an alteration in the patient’s health status that would enhance the likelihood of malnutrition (National Pressure Ulcer Advisory Panel, 2007). It is imperative to assess the patient’s history in regard to pressure ulcer on a regular basis to allow for easy stemming of the condition at the earliest possible opportunity according to the data available on an EHR system. Treatment Process Electronic record-based Assessment The use of an EHR system for the treatment process will enable MICU clinicians to quickly gain access to important information about the assessments of the condition at various stages of pressure ulcer formation, including the problem lists, and choose from among various medical interventions at the click of a button (Thielst, & Gardner, 2008). An examination of the wound and its comparisons with EHR records would be carried out weekly and be implemented in the treatment process (Kerr, 2009). Wound assessment encompasses the body region affected, stage, size, surrounding tissues, exudates, smell, perimeter, ache and an assessment for infection. In most cases, pressure ulcers build on bony tissues (Dahm, & Wadensten, 2008). Stages Pressure ulcers are categorized by classes, with stages running from I to IV. Stage I is marked with an intact skin with non-blanchable reddish colour observed in a localized region, normally over a hard body tissues like bones. Darkly pigmented skin may not have visible blanching; its colour may differ from the surrounding area (National Pressure Ulcer Advisory Panel, 2007). In Stage II, the dermis loses partial thickness (Ayello et al, 2009). This occurrence gives way to a small open ulcer with reddish or pinkish coloured wound bed, lacking slough. The stage may also present an intact or ruptured blister. The third stage is usually marked with the loss of the full skin thickness. The adipose tissue may be visible; however, innermost tissues such as bone, ligaments or muscle tissues are not visible. There may be a slough but its presence does not impede visibility of the nature of the of tissue decay (National Pressure Ulcer Advisory Panel, 2007). The fourth stage is usually marked with a loss of the full thickness of the skin, with visible skin, and tendons. Slough may be available on a number of parts at the base of the wound. Usually, it includes undermining and the complete destruction of the immediate tissues. The “unstagable” phase of pressure ulcer formation witnesses the loss of the full thickness tissue in which the ulcer base is obscured by slough (National Pressure Ulcer Advisory Panel, 2007). Suspected deep injuries to the tissue are marked by purple or maroon colour in the localized area of intact skin that has been discoloured. A blood-filled blister may be observed due to the collapse of soft tissues at the base due to pressure. The part may be heralded by tissue that is sore, hard, damp, boggy, or that which has a different temperature as compared to neighbouring tissue (National Pressure Ulcer Advisory Panel, 2007). Treatment Managing a pressure ulcer encompasses all of the measures employed in preventing reducing the prevalence of the condition. These involve; the effective employment of the pressure-reducing part, changing the patient’s position from time to time; maintaining whole skin; and placing the patient on proper diet (National Pressure Ulcer Advisory Panel, 2007). These measures should already be in the EHR system together the recommended treatment options for the wound should be implemented (Green, & Thomas, 2008). There are simple wound care practices that can be employed in choosing the most appropriate treatments option for the injury and for the victim. System-generated regular reassessments of the injury and its response to the medical intervention should be documented electronically under each patient’s record for easy access and the exploration of treatment options. This is especially important in regard to the elimination of the risk factors that impede the positive responses to treatment. Pressure Reduction Pressure reduction is the most important of all the medical interventions that result in the healing of the pressure ulcer (Clarke et al, 2005). Without the reduction of the pressure around the wound, the injury will not cure. To reduce the pressure on the wound, regular repositioning of the patient by turning him or her must be carried out routinely. Friction must be avoided at all cost or the condition may degenerate into a more serious ulcer with undermining and the collapsing of adjacent tissues through tunnelling process (Ayello et al, 2009). The most appropriate support surface for the carrier of patient must be acquired and used. Control of incontinence will ensure the skin is maintained in good condition. While external hindrances to healing are put in place, the inside risk factors can be eliminated through proper diet and by limiting other aspects that impact on the healing process. Dietician recommendations on the EHR would provide quick and more effective when managing a pressure ulcer (Hagens, & Krose, 2009). Wound management The primary aim of treatment is to provide the best possible environment for the healing of the wound (Ayello et al, 2009). The best environment for the healing process of all tissues and related cells is warm, dark, damp, and covered. In the treatment of the pressure ulcers, it is important to cut off necrotic tissue; treat and prevent infection to the wound; fill the wounds with new tissue; maintain damp wound environment; and safeguard the ulcer from shock, and cold. If these rules are properly outlined in the EHR solution lists, clinicians will find it easy to enter medical interventions and effective clinical care by clinicians. The removal of a necrotic tissue can be removed through surgery, autolyctic process, chemical, biosurgical, or mechanical processes. By availing these rules across the various units, caregivers will have no otherwise but to offer the patient the best recovery care. Conclusion Technology matters a lot when it comes to the management of pressure ulcers. The strategy for pressure ulcer prevention and management results in faster and more accurate use of patient data to initiate effective prevention and treatment outcomes. The system allows health care providers to synchronize data simultaneously for easy analysis of problem lists, medical prescription lists and sensitivity lists. To achieve effective use of the tool, installing the right hardware and software is essential. Additionally, staff training and stepwise implementation programs are a proven way to achieving quantifiable efficiency in the long run. It is also important for the staff involved to work as a team in order to provide high quality care for the patients. References Adler, K.G. (2010). Successful EHR Implementations: Attitude Is Everything. Detail Only Available By: Family Practice Management, 17(6), 9-11. Ayello, E.A., Capitulo, K.L., Fife, C.E., Fowler, E., Krasner, D.L., Mulder, G., Sibbald, R.G., & Yankowsky, K.W. (2009). Legal Issues in the Care of Pressure Ulcer Patients: Key Concepts for Health Care Providers: A Consensus Paper from the International Expert Wound Care Advisory Panel. Journal of Palliative Medicine, 12(11), 995-1008. Clarke, H. F., Bradley, C., Whytock, S., Handfield, S., Van der Wal, R., & Gundry, S. (2005). Pressure ulcers: implementation of evidence-based nursing practice. Journal of Advanced Nursing, 49(6), 578-590. Dahm, M.F., & Wadensten, B. (2008). Nurses’ experiences of and opinions about using standardised care plans in electronic health records – a questionnaire study. Journal of Clinical Nursing, 17(16), 2137-2145. Green, S. D., & Thomas, J. D. (2008). Interdisciplinary collaboration and the electronic medical record. Pediatric Nursing, 34, 225-240. Hagens, S., & Krose, A. (2009). Evolution of a national approach to evaluating the benefits of the electronic health record. Studies in Health Technology and Informatics, 14, 3389-394. Retrieved from MEDLINE with Full Text database. Kerr, N. M. (2009). Is it time to change our perspectives on nursing documentation? MedSurg Nursing. Retrieved from High Beam Research. http://www.highbeam.com/doc/1G1-199461348.html Liang, L. (2007). The gap between evidence and practice. We still have much to learn about Practice and patient factors that affect clinical outcomes. Health Affairs, 26, 119-121. National Pressure Ulcer Advisory Panel. (February, 2007). Pressure ulcer stages. 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