present on admission, pressure ulcers, healthcare-acquired conditions, physician admission documentation, nurse admission documentation



  1. Rogers, Catherine DNP, APRN-BC, CWCN, CWS


PURPOSE: To enhance the learner's competence with information geared toward improving processes to capture present-on-admission pressure ulcers.


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. Analyze the research study presented and its effects regarding identification of present-on-admission pressure ulcers (PrUs) and reduction of healthcare-acquired conditions.


2. Identify implications of proper admission skin assessment and documentation on reimbursement by the Centers for Medicare & Medicaid Services.


3. Implement recommendations from the research study for ways to improve PrU documentation on admission assessment.


ABSTRACT: OBJECTIVE:This study was designed to determine if a process could be built to accurately capture present-on-admission (POA) pressure ulcers (PrUs). Will a formalized electronic process designed to identify, communicate, and document assessment findings of POA PrUs from clinical nurses to admitting physicians reduce missed identification of POA PrUs, improve communication processes, improve physicians' documentation, and improve reimbursement for the hospital?


DESIGN: A before-and-after study design in a single site over a 4-month period compared with the same period during the previous 2 years.


SETTING: An acute-care, 333-bed hospital in the Midwestern United States.




Nurses were the primary study population.


INTERVENTION: The wound assessment screen in the electronic medical record (EMR) was revised to include a new prompt for POA documentation and communication to the admitting physician of the assessment findings.


MAIN OUTCOME MEASURES: An increase in POA PrU reporting and reduction in hospital-acquired condition (HAC) reported PrUs.


RESULTS: A statistically significant change (2010: P < .01, z = 2.507; 2011: P < .01, z = 2.632) was found for POA; HAC also had a statistically significant change (2010: P = .02, z = 2.411; 2011: P < .01, z = 2.781).


CONCLUSIONS: The implementation of the electronic prompt did not contribute to the improvement in the POA and HAC rates because the reduction occurred before the EMR prompt intervention. Changing processes such as EMR upgrades, shared governance, Magnet journey, participation in the National Database of Nursing Quality Indicators, and unit-based nursing councils and skin care champions may have exerted positive forces and contributed to improvement in the communication process between the admitting physicians and the clinical nurses.