Improving Accuracy of Pressure Ulcer Staging and Documentation Using A Computerized Clinical Decision Support System

PURPOSE: The purpose of this study was to evaluate an algorithm designed to assess and document pressure ulcers (PUs) via a computerized clinical decision support (CCDS) system. SUBJECTS AND SETTING: This study was conducted at Ochsner Medical Center, a 500-bed regional referral hospital. Thirty-one nurses, including RNs, LPNs, and student nurses, volunteered to participate in the study. METHODS: The purpose of this descriptive study was to evaluate CCDS, a new tool for PU documentation, in a computer classroom setting. The CCDS program was built as an algorithm based on National Pressure Ulcer Advisory Panel's definitions. The CCDS incorporates descriptions in drop-down menus with required selections in depth, color, and characteristics of the PU by the nurse. The computer program then assigns a PU stage. Each participant used the decision support program to document the characteristics of 5 PUs presented in photographs and determine the stage. Data were analyzed to determine the accuracy of nurses' staging compared to that of the researcher and to test for differences between PU groups (overall accuracy, accuracy in accepting CCDS suggestion, and accuracy when override function used). RESULTS: The results indicate that nurses overall accurately staged PUs 64% of the time when using the CCDS program. However, nurses were significantly more accurate in staging suspected deep tissue injury and stage I PUs when they accepted the CCDS staging versus overriding the suggested stage (P <.01). Bivariate analysis did not identify any association between nurses' characteristics and accuracy in PU staging for suspected deep tissue injury, unstageable ulcers, and stages I and III (P >.05). CONCLUSION: Study findings suggest that the use of the CCDS may improve nurses' ability to stage PUs accurately. The correct staging of a PU is imperative in nursing's documentation and subsequent choice of best practices for improved outcomes.