Examining Evidence-Based Content Related to Hospital Acquired Pressure Ulcer Prevention in Paper and Electronic Health Records

Although there have been great advancements in the Electronic Health Record (EHR), there is a dearth of rigorous research that examines the relationship between the use of electronic documentation to capture nursing process components and the impact of consistent documentation on patient outcomes (Daly, Buckwalter & Maas, 2002; Gugerty, 2006; Maas & Delaney, 2004; Solomon et al., 2000). This retrospective study used a descriptive, non-experimental design with mixed methods to examine evidence based content related to hospital acquired pressure ulcer (HAPU) prevention in both paper records and EHRs and examine how these concepts were represented in a standardized nursing terminology as well as health records for hospitalized patients. There were 67 concepts extracted from clinical based guidelines. Forty of the 67 concepts were cross mapped to the International Classification of Nursing Practice (ICNP) via a broader parent relationship while 14 of the 67 concepts could not be cross mapped. These findings suggest further research is needed to enhance the ability of ICNP to represent the more detailed concepts for nursing interventions for HAPU prevention. An unanticipated finding was a 61% increase in number of consults for wound ostomy continence nurses (WOCNs) sent on at-risk patients in the EHR timeframe (100%) as compared to the paper record timeframe (39%). The increase in consults was attributed to the embedded rule structure of the EHR suggesting an enhancement of clinical decision making in HAPU prevention. The relationship between HAPU incidence and type of health record was also examined and identified a 13% difference in HAPU incidence proportion after implementation of the electronic record (p<0.001). Despite the limitations, this study contributes to nursing knowledge related to documentation of data and retrieval of information regarding nursing care for the prevention of HAPUs. The study also has implications for translational science, which is concerned with the implementation of evidence into professional practice at the point of care (Cummings, Browner & Hulley, 2007). [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]