Implementation of an Evidence-Based, Content-Validated, Standardized Support Surface Algorithm Tool in Home Health Care: A Quality Improvement Project.

Abstract

The purpose of this quality improvement project was to provide a standardized, repeatable, and easy-to-use process for selecting a support surface for prevention or treatment of pressure injuries (PIs). The Wound, Ostomy, and Continence Nurses Society Support Surface Algorithm was chosen to guide clinicians in selection of an appropriate support surface. These clinicians provide services to approximately 465,000 patients across the nation annually. This quality improvement project aimed to establish clinician knowledge and comfort levels when recommending a support surface and providing a standardized way to identify the appropriate support surface once a patient had been identified as at risk. The support surface algorithm was incorporated into our agency's electronic medical record (EMR); we chose this interactive algorithm to facilitate support surface selection among clinicians with no specialized expertise in PI treatment or prevention. Clinicians reported an increase in knowledge and comfort levels in the ability to select an appropriate support surface following implementation of the clinical decision support tool. Benchmarking data illustrated a decrease in the year over year aggregate (September 2018 to September 2021) trending for the Centers for Medicare & Medicaid Services quality outcome measures surrounding potentially avoidable events related to PIs. Implementing the support surface algorithm assisted clinicians with support surface selection, elevated and standardized clinician practice, and reduced potentially avoidable events. As a result of this project, the Wound, Ostomy, and Continence Nurses Society Support Surface Algorithm Tool has been fully integrated into our EMR and is a standardized part of our clinical assessment.