Improving accuracy of pressure ulcer staging and documentation using a computerized clinical decision support system

Area of Science:

• Nursing Informatics
• Clinical Decision Support Systems
• Wound Care

Background:

• Accurate pressure ulcer (PU) staging is critical for effective nursing documentation and treatment planning.
• Existing methods for PU assessment and documentation can be subjective and prone to error.
• Computerized Clinical Decision Support (CCDS) systems offer a potential solution to standardize and improve PU staging accuracy.

Purpose of the Study:

• To evaluate the accuracy and effectiveness of a newly developed algorithm within a CCDS system for assessing and documenting pressure ulcers (PUs).
• To compare nurses' PU staging accuracy using the CCDS system versus traditional methods.
• To identify factors influencing PU staging accuracy when utilizing the CCDS system.

Main Methods:

• A descriptive study was conducted at a 500-bed regional referral hospital involving 31 nurses (RNs, LPNs, student nurses).
• Participants used a CCDS program, algorithm-based on National Pressure Ulcer Advisory Panel definitions, to document characteristics of 5 photographic PUs and assign a stage.
• Data were analyzed to determine overall accuracy, accuracy of accepting CCDS suggestions, and accuracy when using the override function.

Main Results:

• Nurses achieved an overall accuracy of 64% in staging PUs when using the CCDS program.
• Accepting the CCDS staging suggestion resulted in significantly higher accuracy for suspected deep tissue injury and stage I PUs compared to overriding the system (P < .01).
• No significant association was found between nurse characteristics and accuracy for staging suspected deep tissue injury, unstageable, stage I, and stage III PUs.

Conclusions:

• The findings suggest that implementing a CCDS system can enhance nurses' accuracy in staging pressure ulcers.
• Accurate PU staging is fundamental for appropriate nursing documentation and selecting optimal interventions to improve patient outcomes.
• Further integration of CCDS tools in clinical practice may lead to more consistent and reliable PU care.