Sample Reports
The On-Time program is funded by the Agency for Healthcare Research and Quality (AHRQ), with support from the California Healthcare Foundation, to improve long-term care by turning daily documentation into useful information that enhances clinical care planning. These are samples of clinical reports used by front-line teams on a weekly basis to monitor resident status and prompt for changes in the care plan.
Select for print version (PDF File, 170
KB). PDF Help.
Completeness Report /
Nutrition Report /
Behavior Report /
Pressure Ulcer Trigger Summary Report /
Priority Reports
Completeness Report
I. Documentation Completeness: All Shifts
Documentation Item |
7/10/2006 |
7/17/2006 |
7/24/2006 |
7/31/2006 |
Meal Intake |
90.2 |
84.9 |
83.7 |
88.3 |
Bowels |
65.8 |
61.9 |
63.3 |
72.7 |
Bladder |
60.1 |
63.1 |
60.4 |
70.3 |
Behaviors |
72.0 |
74.8 |
76.5 |
81.7 |
II. Summary for Week of 7/31
Total Residents |
30 |
# residents missing ≥75% nutritional intake data |
0 |
# residents missing ≥75% of bowel data |
0 |
# residents missing ≥75% of bladder data |
0 |
# residents missing ≥75% of behavior data |
0 |
III. Documentation Completeness: Night Shift
Documentation Item |
7/10/2006 |
7/17/2006 |
7/24/2006 |
7/31/2006 |
Bowels |
39.7 |
41.6 |
45.2 |
62.9 |
Bladder |
40.6 |
58.0 |
46.5 |
68.1 |
Behaviors |
46.0 |
69.0 |
65.0 |
77.6 |
IV. Documentation Completeness: Day Shift
Documentation Item |
7/10/2006 |
7/17/2006 |
7/24/2006 |
7/31/2006 |
Breakfast |
88.8 |
84.1 |
82.0 |
85.2 |
Lunch |
92.0 |
86.9 |
82.9 |
85.2 |
Bowels |
87.5 |
76.3 |
73.3 |
75.7 |
Bladder |
68.3 |
62.9 |
61.3 |
67.1 |
Behaviors |
87.9 |
83.3 |
82.9 |
81.0 |
V. Documentation Completeness: Evening Shift
Documentation Item |
7/10/2006 |
7/17/2006 |
7/24/2006 |
7/31/2006 |
Dinner |
89.7 |
83.7 |
86.2 |
94.3 |
Bowels |
70.1 |
67.8 |
71.4 |
79.5 |
Bladder |
71.4 |
68.6 |
73.3 |
75.7 |
Behaviors |
82.1 |
72.2 |
81.6 |
86.7 |
VI. Form Consistency Errors
Name |
Resident ID |
Section |
Description |
Sample Resident 1 |
0001119 |
08/01 (E) bladder |
Catheter but Incontinent Urine Count not 0 |
Sample Resident 2 |
0038900 |
08/02 (E) bladder |
Catheter but Incontinent Urine Count not 0 |
Sample Resident 3 |
0082800 |
08/02 (N) bladder |
Catheter but Incontinent Urine Count not 0 |
Sample Resident 4 |
0001117 |
08/03 (E) behaviors |
No Behaviors Observed and Frequent Crying both checked |
Sample Resident 45 |
0047100 |
08/03 (E) behaviors |
No Behaviors Observed and Abusive Language both checked |
VII. Resident Summary Details: Sample
Name |
Resident ID |
Section |
% Complete |
______________________ |
X |
Behaviors |
85.7 |
______________________ |
X |
Bladder |
71.4 |
______________________ |
X |
Bowels |
66.7 |
______________________ |
X |
Meals |
95.2 |
______________________ |
X |
Behaviors |
76.2 |
______________________ |
X |
Bladder |
71.4 |
|
X |
Bowels |
76.2 |
|
X |
Meals |
90.5 |
______________________ |
X |
behaviors |
85.7 |
______________________ |
X |
Bladder |
71.4 |
______________________ |
X |
Bowels |
81.0 |
______________________ |
X |
Behaviors |
71.4 |
______________________ |
X |
Bladder |
66.7 |
Top of Page
Nutrition Report
High Risk (Decreased Meal Intake and Weight Loss)
Resident Name |
Resident ID |
Decreased Intake |
Avg Meal Intake % Wk. 07/10/06 |
Avg Meal Intake % Wk. 07/17/06 |
Avg Meal Intake Wk. % 07/24/06 |
Avg Meal Intake % Wk. 07/31/06 |
Wt. Change lbs. |
History Resolved PU |
Most Recent Ulcer Assess Date |
# PUs |
Sample Resident 1 |
0001119 |
7/31/2006 |
73 |
51 |
61 |
52 |
-2.3 |
|
- |
- |
Sample Resident 2 |
0038900 |
7/31/2006 |
0 |
7 |
33 |
36 |
-6.2 |
|
7/19/2006 |
1 |
Medium Risk (Decreased Meal Intake or Weight Loss)
Resident Name |
Resident ID |
Decreased Intake |
Avg Meal Intake % Wk. 07/10/06 |
Avg Meal Intake % Wk. 07/17/06 |
Avg Meal Intake Wk. % 07/24/06 |
Avg Meal Intake % Wk. 07/31/06 |
Wt. Change lbs. |
History Resolved PU |
Most Recent Ulcer Assess Date |
# PUs |
Sample Resident 1 |
0000000 |
07/31/2006 |
32 |
34 |
40 |
42 |
- |
|
- |
- |
Sample Resident 2 |
1111111 |
07/31/2006 |
76 |
76 |
- |
71 |
- |
|
- |
- |
Sample Resident 3 |
0001119 |
08/02/2006 |
49 |
36 |
44 |
54 |
- |
|
- |
- |
Sample Resident 4 |
0038900 |
08/01/2006 |
74 |
78 |
- |
64 |
- |
|
- |
- |
Sample Resident 5 |
0082800 |
07/31/2006 |
56 |
23 |
43 |
43 |
- |
|
- |
- |
Sample Resident 6 |
0001117 |
07/31/2006 |
41 |
23 |
28 |
47 |
- |
|
- |
- |
Sample Resident 7 |
0047100 |
08/04/2006 |
73 |
71 |
71 |
62 |
- |
|
- |
- |
Weight Summary
Resident Name |
Resident ID |
Wt. 180 Days Prior |
Wt. 90 Days Prior |
Wt. For Wk. 07/10/06 |
Wt For Wk. 07/17/06 |
Wt. For Wk. 07/24/06 |
Wt. For Wk. 07/31/06 |
Wt. Change lbs. |
Date 5-10% Wt. Loss ≤ 30 Days |
Date > 10% Wt. Loss ≤ 180 Days |
Sample Resident 1 |
0000000 |
- |
- |
139 |
- |
139 |
140 |
1 |
- |
- |
Sample Resident 2 |
1111111 |
- |
- |
- |
- |
- |
- |
- |
- |
- |
Sample Resident 3 |
0001119 |
- |
- |
159 |
159 |
- |
- |
0 |
- |
- |
Sample Resident 4 |
0038900 |
- |
- |
- |
- |
- |
- |
- |
- |
- |
Top of Page
Behavior Report
Number of Residents with Behaviors by Shift: Unit Snapshot
Shift |
Frequent
Crying |
Yell/ Scream |
Kicking/ Hitting |
Pinch/ Scratch/ Spit |
Biting |
Wandering |
Abusive Language |
Threatening Behavior |
Resists
Care |
Repititive
Verbalization |
Repititive
Movement |
Sexually Inappropriate Behavior |
D |
2 (6%) |
4 (13%) |
1 ( 3%) |
0 ( 0%) |
0 (0%) |
4 (13%) |
2 ( 6%) |
2 ( 6%) |
2 ( 6%) |
4 (13%) |
2 (6%) |
0 (0%) |
E |
1 (3%) |
4 (13%) |
1 ( 3%) |
0 ( 0%) |
0 (0%) |
4 (13%) |
2 ( 6%) |
1 ( 3%) |
5 ( 17%) |
5 ( 17%) |
1 (3%) |
0 (0%) |
N |
3 (10%) |
3 (10%) |
0 ( 0%) |
0 ( 0%) |
0 (0%) |
0 ( 0%) |
1 ( 3%) |
0 ( 0%) |
3 ( 10%) |
3 ( 10%) |
2 (6%) |
0 (0%) |
All |
5 (17%) |
5 (17%) |
1 ( 3%) |
0 ( 0%) |
0 (0%) |
5 ( 17%) |
2 ( 6%) |
2 ( 6%) |
6 ( 20%) |
5 ( 17%) |
3 (10%) |
0 (0%) |
Name |
Resident
ID |
Shift |
Frequent Crying |
Yell/ Scream |
Kicking/ Hitting |
Pinch/ Scratch/ Spit |
Biting |
Wandering |
Abusive Language |
Threatening Behavior |
Resists Care |
Repititive Verbalization |
Repititive Movement |
Sexually Inappropriate Behavior |
Total # of Behaviors |
______________________ |
X |
D |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
1 |
0 |
2 |
______________________ |
|
E |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
3 |
0 |
6 |
______________________ |
|
N |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
______________________ |
X |
D |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
1 |
0 |
0 |
3 |
______________________ |
|
E |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
3 |
0 |
0 |
7 |
______________________ |
|
N |
3 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
1 |
1 |
0 |
9 |
______________________ |
X |
D |
0 |
6 |
0 |
0 |
0 |
0 |
5 |
0 |
0 |
0 |
0 |
0 |
11 |
|
|
E |
0 |
5 |
0 |
0 |
0 |
0 |
4 |
0 |
0 |
0 |
0 |
0 |
9 |
|
|
N |
0 |
7 |
0 |
0 |
0 |
0 |
6 |
0 |
0 |
0 |
0 |
0 |
13 |
______________________ |
X |
D |
0 |
1 |
1 |
0 |
0 |
2 |
0 |
1 |
1 |
1 |
0 |
0 |
7 |
______________________ |
|
E |
0 |
1 |
1 |
0 |
0 |
4 |
0 |
2 |
1 |
2 |
0 |
0 |
11 |
______________________ |
|
N |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Top of Page
Pressure Ulcer Trigger Summary Report
Number of Residents and the Percentage of the Unit Within Each Trigger by Week
Pressure Ulcer Triggers |
Week 1 |
Week 2 |
Week 3 |
Week 4 |
|
2006-07-10 |
2006-07-17 |
2006-07-24 |
2006-07-31 |
Wt. Loss 5-10% in ≤ 30 Days |
- |
- |
- |
- |
Wt. Loss > 10% in ≤ 180 Days |
- |
- |
- |
- |
2 Meals ≤ 50% in 1 Day |
6 (18%) |
8 (23%) |
8 (23%) |
8 (22%) |
Weekly Meal Intake Average < 50% |
4 (12%) |
7 (20%) |
5 (14%) |
4 (11%) |
Daily Urine Incontinence |
10 (30%) |
16 (47%) |
13 (38%) |
15 (41%) |
> 3 Days Bowel Incontinence. |
13 (39%) |
18 (52%) |
12 (35%) |
15 (41%) |
Catherized |
10 (30%) |
16 (47%) |
8 (23%) |
12 (33%) |
History of Resolved Ulcer |
- |
- |
- |
- |
Current Pressure Ulcer |
- |
- |
- |
- |
Pressure Ulcer Trigger Summary by Resident for Current Week
Name |
Resident ID |
Wt. Loss 5-10% in ≤ 30 Days |
Wt. Loss > 10% in ≤ 180 Days |
2 Meals < 50% in 1 Day |
Weekly Meal Intake Average < 50% |
Daily Urine Incontinence. |
> 3 Days Bowel Incontinence |
Catheter |
History of Resolved Ulcer |
Current Pressure Ulcer |
# of Triggers Last Week |
# of Triggers This Week |
______________________ |
X |
|
|
X |
X |
X |
X |
|
|
|
3 |
4 |
______________________ |
X |
|
|
|
|
X |
X |
X |
|
|
2 |
3 |
______________________ |
X |
|
|
X |
|
|
X |
X |
|
|
5 |
3 |
______________________ |
X |
|
|
|
|
X |
X |
X |
|
|
0 |
3 |
______________________ |
X |
|
|
|
|
X |
X |
X |
|
|
2 |
3 |
______________________ |
X |
|
|
X |
|
|
X |
X |
|
|
0 |
3 |
|
X |
|
|
X |
X |
|
|
X |
|
|
3 |
3 |
______________________ |
X |
|
|
|
|
X |
X |
|
|
|
1 |
2 |
______________________ |
X |
|
|
X |
|
|
|
X |
|
|
1 |
2 |
______________________ |
X |
|
|
|
|
|
X |
X |
|
|
3 |
2 |
Top of Page
Priority Reports
Priority Report
Name |
Resident ID |
Decreased Meal + Wt. Loss |
Wt. Loss ≥5% Last 30 Days |
Incontinence Increase |
Different Behaviors ≥ 31 |
Worsening Ulcer |
New Ulcer |
Open Area |
Resident Name |
0001122 |
|
|
|
3* |
|
|
|
Resident Name |
0079601 |
|
|
X |
|
|
|
X |
Resident Name |
0052124 |
|
|
X |
4* |
|
|
|
Resident Name |
0001637 |
|
|
X |
|
|
|
|
Resident Name |
0003242 |
|
|
X |
4 |
|
|
|
Resident Name |
0039624 |
|
|
X |
|
X |
|
|
Resident Name |
0065677 |
|
|
|
|
|
|
X |
Resident Name |
0002146 |
|
|
X |
|
X |
X |
X |
1Definition
Behaviors ≥ 3: If 2 or more
different behaviors present for the report week that did not present during previous week
AND total number of behaviors ≥ 3, display total number of behaviors with asterisk next to number (asterisk indicates 2
or more additional, different behaviors from previous report week).
Examples
If < 3 different behaviors THEN leave behaviors column blank
If ≥ 3 different behaviors for current week THEN display total # behaviors
If ≥ 3 different behaviors for current week AND increase in total # of
different behaviors from previous week by
≥ 2 THEN display # behaviors for current week and asterisk next to number
Residents with Red Areas
Name |
Resident Id |
Red Area |
Resident Name |
0001119 |
X |
Resident Name |
0038900 |
X |
Resident Name |
0082800 |
X |
Resident Name |
0001117 |
X |
Resident Name |
0047100 |
X |
Top of Page
Current as of November 2008
Internet Citation:
On-Time Quality Improvement for Long-term Care: Sample Reports. November 2008. Rockville, MD; Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/ltc/pusamplerep.htm