Bates-Jensen Barbara M, Cadogan Mary, Jorge Jennifer, Schnelle John F
Division of Geriatrics, School of Medicine, University of California, Los Angeles, California, USA.
J Am Geriatr Soc. 2003 Sep;51(9):1194-202. doi: 10.1046/j.1532-5415.2003.51402.x.
To demonstrate reliability and feasibility of a standardized protocol to assess and score quality indicators relevant to pressure ulcer (PU) care processes in nursing homes (NHs).
Descriptive.
Eight NHs.
One hundred ninety-one NH residents for whom the PU Resident Assessment Protocol of the Minimum Data Set was initiated.
Nine quality indicators (two related to screening and prevention of PU, two focused on assessment, and five addressing management) were scored using medical record data, direct human observation, and wireless thigh monitor observation data. Feasibility and reliability of medical record, observation, and thigh monitor protocols were determined.
The percentage of participants who passed each of the indicators, indicating care consistent with practice guidelines, ranged from 0% to 98% across all indicators. In general, participants in NHs passed fewer indicators and had more problems with medical record accuracy before a PU was detected (screening/prevention indicators) than they did once an ulcer was documented (assessment and management indicators). Reliability of the medical record protocol showed kappa statistics ranging from 0.689 to 1.00 and percentage agreement from 80% to 100%. Direct observation protocols yielded kappa statistics of 0.979 and 0.928. Thigh monitor protocols showed kappa statistics ranging from 0.609 to 0.842. Training was variable, with the observation protocol requiring 1 to 2 hours, medical records requiring joint review of 20 charts with average time to complete the review of 20 minutes, and the thigh monitor data requiring 1 week for training in data preparation and interpretation.
The standardized quality assessment system generated scores for nine PU quality indicators with good reliability and provided explicit scoring rules that permit reproducible conclusions about PU care. The focus of the indicators on care processes that are under the control of NH staff made the protocol useful for external survey and internal quality improvement purposes, and the thigh monitor observational technology provided a method for monitoring repositioning care processes that were otherwise difficult to monitor and manage.
证明一种标准化方案在评估和评分与养老院压疮（PU）护理过程相关的质量指标方面的可靠性和可行性。
描述性研究。
八家养老院。
启动了最小数据集的PU居民评估方案的191名养老院居民。
使用病历数据、直接人工观察和无线大腿监测器观察数据对九个质量指标（两个与PU的筛查和预防相关，两个侧重于评估，五个涉及管理）进行评分。确定了病历、观察和大腿监测器方案的可行性和可靠性。
所有指标中，通过各指标（表明护理符合实践指南）的参与者百分比在0%至98%之间。总体而言，与溃疡记录后（评估和管理指标）相比，养老院的参与者在PU被检测到之前（筛查/预防指标）通过的指标更少，病历准确性方面的问题更多。病历方案的可靠性显示kappa统计值在0.689至1.00之间，一致性百分比在80%至100%之间。直接观察方案产生的kappa统计值为0.979和0.928。大腿监测器方案的kappa统计值在0.609至0.842之间。培训情况各不相同，观察方案需要1至2小时，病历需要联合审查20份图表，平均完成审查时间为20分钟，大腿监测器数据需要1周时间进行数据准备和解释方面的培训。
标准化质量评估系统为九个PU质量指标生成了具有良好可靠性的分数，并提供了明确的评分规则，允许对PU护理得出可重复的结论。指标对养老院工作人员可控的护理过程的关注使得该方案对外部调查和内部质量改进目的有用，并且大腿监测器观察技术提供了一种监测否则难以监测和管理的重新定位护理过程的方法。
