1. Salcido, Richard "Sal MD"

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The seamless linkages of quality improvement principles and practices to novel health information technologies1 are now possible. Their inherent capacities have accelerated to levels beyond what was prophesied by Moore's law,2 where he predicted computer capacities would double every 2 years. Inpatient settings in hospitals, skilled nursing facilities, and home health programs are acquiring new technologies at a rapid pace.3 These devices and systems are designed for a variety of point-of-service activities, including documentation-a far cry from the "pen and paper" or meaningless phrases in the daily note, such as "no significant interval change"-or patient turned "Q2 hours." However, the strongest link in the chain with the most capacity and need for knowledge transfer is not a computer; it is the actual caregiver. In this case, it is the certified nursing assistant (CNA).

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As we move into the knowledge economy, workers will have to increase their capacity for facile integration of these technologies to provide better care at the micro (point of service) level and gather information that will be used at the macro level to enhance overall care practices through packaging, processing, and dissemination of various knowledge packets that derive from the collective work of individuals and collaborative providers in the wound prevention and care field. Privately held, publicly traded, university and Veterans Affairs healthcare providers must invest in educational continuous quality improvement programs and projects that will ensure the clinical competencies of frontline providers, especially in the area of wound care practice within a system of care.4



Staff at the bedside must demonstrate an awareness of and responsiveness to the larger context and system of healthcare. Certified nursing assistants must know how to partner with healthcare managers and healthcare providers to assess, coordinate, and improve healthcare-knowing these activities can affect the overall system of performance of the organization and the professional satisfaction of CNAs.


This month's continuing education activity by Sharkey et al on page 83 is illustrative of the practices that can be used to enhance systems-based practices through partnering with frontline staff. This practice is exemplified by usage of an On-Time Quality Improvement for Pressure Ulcer Prevention program and the integration of health information technology tools into practice at the unit level. The major thrust of the venture was to leverage documentation and knowledge of CNA staff that serve as "primary informants to licensed staff."


My deference is to CNAs, as they provide most of the usable human intelligence for the systems of care. Healthcare providers and educators have a unique responsibility and opportunity to provide more sophisticated education for our CNAs. They are very important links in the chain of care and information relative to advancing the sophistication of technology that is rapidly permeating the wound prevention and care space.




1. Electronic Health Record Systems. In: Shortliffe EH, Cimino JJ, eds. Biomedical informatics: Computer Applications in Health Care & Biomedicine. New York, NY: Springer; 2006:447-75. [Context Link]


2. Jovanovic B, Rousseau PL. "Moore's Law and Learning by Doing." Review of Economic Dynamics 2002; 5: 346-75. [Context Link]


3. Kieser DC, Hammond C. Leading wound care technology: the ARANZ medical silhouette. Adv Skin Wound Care 2011; 24: 68-70. [Context Link]


4. McKean SC, Budnitz TL, Dressler DD, Amin AN, Pistoria MJ. How to use the core competencies in hospital medicine: a framework for curriculum development. J Hosp Med 2006; 1 Suppl 1: 57-67. [Context Link]