Top 5 Digital Tips to Reduce Hospital-Acquired Pressure Injuries

Make you, your leaders, and patients happy by avoiding HAPIs

All clinicians strive to prevent hospital-acquired pressure injuries (HAPIs)…and for good reason. Stage III, Stage IV, and unstageable HAPIs are categorized as “never events” under the CMS Hospital-Acquired Condition (HAC) program1 and can lead to substantial penalties and lost reimbursement. About 2.5 million patients acquire a pressure injury while in the hospital at a cost of almost $12 billion annually.2 More than 25% of elderly patients have at least one wound upon admission to the hospital.3

Treating and preventing pressure ulcers and wounds isn’t always easy. It can be time-consuming, subject to individual variables, hard to document and track, and difficult for busy clinicians to treat. Because of their complexity, traditional wound care often presents a recipe for missed opportunities for meaningful outcomes, higher satisfaction rates and optimal reimbursement. So, what can be done to prevent HAPIs? A few of the more promising innovations include the growth of automated mobile wound and skin imaging and predictive analytics solutions, such as those pioneered by Net Health. A recent webinar highlighted the five key ways digital techniques can reduce HAPIs:

1. Provide Accurate and Comprehensive Documentation

In the majority of hospitals today, it’s common to see a wound care nurse with a ruler, pen and paper.Typically, the information he orshe records following a patient encounter is then manually entered into the EHR. This process is time-consuming and can lead to errors.Manual wound measurement has other drawbacks. One of the most significant is the rate of measurement variability among individual clinicians using different techniques to measure the same wound.For some, it’s center to edge and for others, it’s edge to edge. Some include the callous around the wound; others don’t. As reported in the webinar, that’s one reason why there’s an error rate of 40% or more in wound measurement. Consistent and documented wound assessments are especially important at admission. Accurate documentation helps drive quality care from inpatient admission, to discharge, to follow-up outpatient visits.When digital techniques are used, the results can be significant. George WashingtonUniversity Hospital found that their woundcare process was 57% faster and 34%more precise using Tissue Analytics.4 Most importantly, such technology can reduce errors to negligible rates while improving accuracy and ultimately, outcomes.

2. Improve Workflow for Busy Clinicians

If there’s one thing clinicians today don’t have, it’s time. When MDs or RNs are asked to complete additional tasks, such as documenting a wound’s status, the process is more effective when it is streamlined, simple and seamless with their workflow.That’s not what happens in many woundcare settings today. A clinician sees a patient, makes notes about the patient encounter(again, often on any piece of paper available),goes back to the office to transcribe those notes, and then the narrative is manually input into the EHR. Those steps easily take 30minutes or more.5Most clinicians will tell you they didn’t going their chosen profession to engage in“death by click- charting.” Technology is oneway to reunite caregivers with their calling and ensure they have time to provide hands care to patients.

Digital techniques can help to automate and integrate workflow and streamline previously time-consuming tasks, saving significant documentation time for a clinician, and leaving them more time to provide care.Tissue Analytics simplifies the process further by offering smart text phrasing that becomes part of the documentation. That same case that used to take 30 minutes to document is easily completed in well under five minutes. Plus, the information flows directly into the patient’s chart with clear notes that provide up-to-date and at-a-glance insights into the patient status.

3. Foster Mobile Documentation and Assessment

Over the past few years, one of the more popular innovations in wound care has been the incorporation of mobile documentation through smartphone technology. Clinicians can now complete wound care documentation with an app on their mobile device, giving them more flexibility and ease in documenting wounds efficiently. These apps safeguard patient privacy by ensuring all images are immediately uploaded to the EHR and never stored on the mobile device. With Tissue Analytics, product formularies can also be included on the mobile app providing rapid clinical decision support.

While nurses appreciate the use of mobile devices in wound care, physicians and nursing managers appreciate the insights provided by web analytics. For example, after a nurse sends an image to the platform, data can be compiled into a pie chart that shows the status of a wound at-a-glance.By color coding key wound indicators, clinicians can see how it is trending. Color coding also ensures consistent use of language. Clinicians can’t always speak accurately about common wound terms such as slough, eschar and spread of necrotic tissue. A color-coded wound piechart gives all clinicians the snapshot they need to see status and trends.6

4. Provide Technology-Enabled Imaging

The right image is worth much more than 1,000 words when it comes to wound care. Technology-enabled imaging is more efficient for the clinician and less invasive for the patient, as time spent assessing and measuring wounds can be painful for patients. Using digital techniques, the wound can be visually captured without putting undue stress on the patient. Most importantly, because measurement is more accurate, the overall time spent on healing is reduced.However, simply taking a photo of a wound is not enough to provide clinical guidance (such as selecting the right product for the wound),ensure documentation, or show how the status of a wound changes over time. Poor quality photos can even negate the value and functionality of digital systems.

Conversely, technology that provides guidance on image quality and protocols such as lighting, distance, and angles, helps ensure consistent, high-quality images that are of value to the treatment process.One more important step to ensuring optimal results from digital imaging is knowing when to take your photos. That guidance is easily remembered through the “4 Eyes” mnemonic. Initially started by nurses attending a wound care conference, the guidance is now widely used and important to remember. It states that clinicians should take pictures. . .• Within 4 hours of admission• Within 4 hours of transfer• If that patient has been off unit for more than 4 hours• Every Wednesday (Woundsday)• Any new wound observed

5. Track Wounds Across the Care Continuum

A patient’s healthcare journey may take them from an inpatient admission to a skilled nursing facility (SNF) unit to outpatient wound care visits. Tracking that journey and the status of wounds along that pathway, is an important step for providers. WithTissue Analytics, images are in a single repository and clinicians can track images pre- and post-discharge to better monitor the wound’s progress.In wound care, clinicians are always looking at outcomes and trends. One of the best ways to determine those trends is to track a wound’s status longitudinally. This step provides important data around progress and healing time. For wound care providers, the goal is always to be more efficient and to have better data. Harnessing technology enables clinicians to better determine a treatment course, and with that knowledge, improve patient outcomes. There is nothing more satisfying to a clinician using TissueAnalytics than to hit the green button marked healed!

The more data you capture, the more data you can use to infer meaningful insights that drive improvement for patients and opportunities for increased efficiency in your hospital’s wound care strategy. Many customers that implement a digital woundcare application report increased efficiency among their clinical staff. The result is the improvement of a key clinical program and reduced risk of costs associated with HAPIs.Wound care enables clinicians to track patients across the entire continuum.It does this by:

• Providing a single repository for images
• Removing photo acquisition variability
• Ensuring consistent measurements, regardless of clinician
• Standardizing documentation integrating with EHR
• Offering access for patients to remote imaging platforms
• Creating the ability for remote consults and visits

Bringing it all Together: Documenting Progress and Meeting Care Goals

The goal of any wound care program is to ensure quality care, improve outcomes, reduce penalties and enhance revenue. As the Agency for Healthcare Research and Quality (AHRQ) reports that the cost of individual patient care for HAPIs ranges from $20,900to $151,700 per injury7, these are critical goals for today’s hospitals to achieve. Based on those stats, consider that the average 300-bed hospital could incur costs of$2 million for excessive HAPIs.Those are dollars vital to financially burdened facilities of today.

Reducing risk and maximizing performance begins with the reporting and sharing of data to ensure that quality, operational and care goals are met. Information that can be shared in Tissue Analytic reports includes:• Overall facility wound-healing rates• Benchmarks against national averages• Wound healing rates within department, floors, and staff

Wound care data should also provide actionable data and information. Woundcare EHR audits drill down to useful insights such as who are the super users, who is and isn’t using the technology, and usage and performance by departments and individuals. Other key data includes whether or not the wound was community- or hospital-acquired. With severe penalties for HAPIs, good documentation and reporting is critical knowledge for any hospital to have. With Tissue Analytics – when an image of a wound is taken with the app, the user is required to note in the chart if it was present upon admission or not. Users can’t send the image to the EHR unless that data is provided, ensuring vital documentation is recorded. The value of digital techniques for woundcare is being shown at hospitals every day.They bring efficiencies, improve care and reduce penalties. Most importantly, they can be used to reunite providers with their true calling: caring for patients.

SOURCES

1 CMS.Gov. Hospital Acquired Conditions. 2020.

2 AHRQ. Preventing Pressure Ulcers in Hospitals. 2014.

3 Wound Repair Regen. Prevalence of pressure ulcers on hospital admission among nursing home residents transferred to the hospital. May-June, 2008.

4-6 Net Health Webinar. Top Digital Techniques to Reduce Hospital-Acquired Pressure Injuries with Kara Couch. June 25, 2020.

7 AHRQ. Module 1: Preventing Pressure Injuries in Hospitals—Understanding Why Change Is Needed. 2017.