ISCAP Proceedings: Abstract Presentation
Putting Knowledge Where It's Needed - Development of a Pressure Injury Clinical Decision Support System
Amy Campbell
University of South Alabama
Matt Campbell
University of South Alabama
Joyce Pittman
University of South Alabama
Betina Riley
University of South Alabama
Jo Ann Otts
University of South Alabama
Abstract
Hospital-acquired pressure injuries (HAPI) affect more than 2.5 million people and increase healthcare costs by more than $26.8 billion in the US every year. Effective training on identifying pressure injuries (PI) could allow providers (e.g., nurses and relative caregivers) to quickly identify patients at risk for pressure injuries (PIs) and implement prevention strategies to significantly reduce these numbers. However, preventing and identifying pressure injuries can be a challenge for even experienced healthcare providers. The issues that make PI care so difficult include:
1. PIs appear different on different skin tones.
2. Expanded use of medical equipment and presence of personal items such as cell phone in the clinical environment can lead to PIs that a clinician may be unfamiliar with.
3. Risk and treatment of PIs are treated differently at each facility.
4. Knowledge of how to prevent, recognize, and effectively treat PIs is usually gained with experience; however, high turnover and retirement of baby boomers have reduced experienced nurses in the field.
The goal of this project is to create a clinical decision support (CDS) tool that walks nurses through the skin assessment process to successfully identify current PIs, identify risks to skin health and barriers to any interventions, and to provide the nurse current evidence-based interventions on preventing skin breakdown – effectively providing the nurse technological tools to develop from novice to expert. As the nurse becomes more proficient in the skill of performing a skin assessment the tool will accommodate the nurse’s understanding while still providing CDS. To accomplish this, we assembled a diverse stakeholder group of content experts (nurses/clinicians), patients, and relative caregivers who contributed information on prevention and treatment of PIs, provided use cases, piloted the app, and then provided iterative feedback on the app design and functionality.
The CDS tool was created as a web application to allow clinicians and other care providers to use the tool on their smart phone or other mobile device at the bedside. This improves data accuracy and system ease of use. After the care provider has entered in the appropriate information, the system can automatically generate care notes that can be entered into patient’s electronic health record, patient education material, and can instruct the patient and/or their family members on how to better care for PIs.
Medical apps can face strict regulation from the US Food and Drug Administration if they appear to be intended to diagnose or treat a particular illness or condition. Our CDS system, however, is careful not to do this. Our system guides the care provider through the decision-making process by providing them with the specific information they need at just the right time in order to make the best decision. In addition, the system does not collect or retain any patient-specific information and therefore is not subject to the requirements of HIPAA.
This research was funded by a grant from Smith + Nephew.