Implementation of Wound Photography for Pressure Injury Documentation in Trauma

Abstract

Problem: Pressure injuries that are present on admission but not documented within 24 hours of admission are deemed a hospital acquired pressure injury (HAPI) per Centers for Medicare & Medicaid Services (CMS) guidelines. Anecdotal data has reported at least three known cases of patients admitted via the admitting trauma unit of an academic medical center with a pressure injury (PI) that was not documented in the electronic health record (EHR) within 24 hours of admission. This documentation deficit can have a significant impact since the financial burden of any PI deemed a HAPI is the responsibility of the organization. Purpose: The purpose of this evidenced-based quality improvement (QI) project was to implement and evaluate the effectiveness of wound photography via a smartphone application on PI documentation in the EHR for patients treated in the admitting trauma unit. Methods: Wound photography was implemented as method to document a PI in a timely manner. Educational resources were provided to the staff nurses prior to implementation. Throughout implementation, barriers to workflow changes were addressed to facilitate compliance with wound photography PI documentation. PI documentation compliance at 24-hours post admission from outside hospital (OSH) was compared using a chi-square test of independence. Results: The findings presented numerous challenges educating the nursing staff due to the limited time that can be spent on unit, therefore a virtual learning platform was used as a primary method to educate the staff. Of the seven patients admitted with a PI, all PIs were documented with wound photography. According to the WOCN, there were no incidents of missed PI documentation within 24 hours of admission from the trauma admitting unit for the duration of this QI project. Conclusions: The conclusions suggest that wound photography is a valuable and simple tool that could increase efficiency of PI documentation in a fast-paced level I admitting trauma unit.