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Nursing home quality improvement, pressure ulcer prevention, health information technology tools for clinical decision making



  1. Sharkey, Siobhan MBA
  2. Hudak, Sandra MS, RN
  3. Horn, Susan D. PhD
  4. Barrett, Ryan
  5. Spector, William PhD
  6. Limcangco, Rhona PhD


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.