Exploratory Study of Nursing Home Factors Associated with Successful Implementation of Clinical Decision Support Tools for Pressure Ulcer Prevention

Abstract

In Brief PURPOSE: To enhance the learner’s competence with information about a study examining nursing home factors associated with the On-Time Quality Improvement for Pressure Ulcer Prevention program clinical decision support tools. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Interpret study components that increase successful implementation of the On-Time program. 2. Apply findings of this study in planning for implementation of a similar program for prevention of pressure ulcers. OBJECTIVES: To determine those factors that are associated with nursing homes’ success in implementing the On-Time quality improvement (QI) for pressure ulcer prevention program and integrating health information technology (HIT) tools into practice at the unit level. DESIGN: Observational study with quantitative analysis of nursing home characteristics, team participation levels, and implementation milestones collected as part of a QI program. SETTING: Fourteen nursing homes in Washington, District of Columbia, participating in the On-Time Pressure Ulcer Prevention program. MAIN OUTCOME MEASURES: The nursing home level of implementation was measured by counting the number of implementation milestones achieved after at least 9 months of implementation effort. MAIN RESULTS: After at least 9 months of implementation effort, 36% of the nursing homes achieved level III, a high level of implementation, of the On-Time QI-HIT program. Factors significantly associated with high implementation were high level of involvement from the administrator or director of nursing, high level of nurse manager participation, presence of in-house dietitian, high level of participation of staff educator and QI personnel, presence of an internal champion, and team’s openness to redesign. One factor that was identified as a barrier to high level of implementation was higher numbers of health inspection deficiencies per bed. CONCLUSION: The learning from On-Time QI offers several lessons associated with facility factors that contribute to high level of implementation of a QI-HIT program in a nursing home. This continuing education activity determines those factors that are associated with nursing homes’ success in implementing the On-Time Quality Improvement for Pressure Ulcer Prevention program and integrating health information technology tools into practice at the unit level.