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BACKGROUND/RATIONALE:
Improving quality in VA affiliated nursing homes (NHs) is imperative. Implementation of clinical practice guidelines is one strategy to improve quality. Guideline implementation in NHs presenta a unique challenge because over 80-90% of direct resident care is provided by paraprofessionals - certified nursing assistants (CNAs). CNAs perform many provider-level care processes linked with guideline implementation.
Measurement of CNA performance of care processes related to guideline implementation is challenging. NH medical record documentation has been shown to be inaccurate. Self-reporting of provider behaviors has inherent limitations. Directly observing CNAs using a traditional work-sampling methodology and a personal digital assistant (PDA) may provide valid and reliable measuments of CNA performance of guideline related care processes.
OBJECTIVE(S):
Objectives: To modify and test a PDA-based measurement of pressure ulcer prevention guideline implementation by certified nursing assistants (CNAs). The modification and testing will be based on lessons learned from preliminary pilot study findings and modifications need to use the PDA-based measurement strategy for the intervention under development - Targeted Supervisory Feedback. Study questions are:
1. What percentage of CNA time on average is sued to perform care processes related to implementation of pressure ulcer prevention guidelines?
2. Does the percentage of CNA time used to perform care processes related to implementation of pressure ulcer prevention guidelines vary by percentage of high-risk residents in the facility during the data collection periods?
METHODS:
This is a descriptive observational study. A work sampling methodology will be used to collect the sample of work observations. A convenience sample of CNAs will be used. Each observational episode for data collecting is a 30 second period every three minutes. After the 30 seconds of observation, the data will be recorded on the PDA. Each discretely defined work activity is a unit of analysis. Descriptive statistics, including counts, means, percentages, and Pearson's r
correlation will be used to analyze the data.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Veterans requiring nursing home care obtain care at VA-operated facilities, state veterans homes, and community-contract facilities. In all these settings, it is necessary to implement the prevention of pressure ulcers. This observational strategy will be useful as a measurement tool for research and as a real-time quality improvement measurement for care delivered to Veterans in nursing homes.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes
DRE:
none
Keywords:
none
MeSH Terms:
none
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