Table 4.
Measures of Licensed Nurse Care Processes
| 1 | 2 | 3 | ||
|---|---|---|---|---|
| Licensed Nurse Care Process Indicators | Low Homes <25th Percentile % (n/total n) | High Homes 75–90th Percentile % (n/total n) | Highest Homes 91st+Percentile % (n/total n) | Significant Comparisons |
| ACOVE Pressure Ulcer Indicators: Medical Record Data | ||||
| 1. Percent of participants admitted with inability or limited ability to reposition him- or herself who have a pressure ulcer risk assessment on admission. | 92 (84/91) | 32 (24/74) | 46 (27/59) | 1 and 2 vs. 3* |
| 2. Percent of participants identified as “at risk” (e.g., Minimum Data Set [MDS] assessment indicates Pressure Ulcer Resident Assessment Protocol initiated) for pressure ulcer development who have documentation of all three: scheduled repositioning every two hours, pressure reduction, and nutritional status assessment for pressure ulcer prevention. | 78 (104/133) | 32 (34/106) | 57 (33/58) | 1 and 2 vs. 3* |
| 3. Percent of participants with a pressure ulcer present or history of a pressure ulcer within the previous 12 months who have four characteristics of the wound documented (e.g., location, stage, size, and presence or absence of necrotic tissue) | 38 (20/53) | 36 (11/31) | 25 (4/16) | – |
| ACOVE Incontinence Indicators: Medical Record Data | ||||
| 4. Percent of participants with assessment of presence or absence of urinary incontinence on admission | 100 (119/119) | 92 (72/78) | 97 (68/70) | |
| 5. Percent of incontinent participants with at least two of three of the following assessed: fecal impaction, skin examination, genital system examination | 35 (13/37) | 13 (3/24) | 20 (8/41) | |
| 6. Percent of incontinent participants with a targeted history that documents at least two or more of the following: mental status, voiding characteristics, ability to get to the toilet, prior incontinence treatment, and importance of incontinence to resident. | 100 (37/37) | 78 (18/23) | 88 (35/40) | |
| 7. Percent of incontinent participants who have documented an evaluation of a 3–5 day toileting assistance trial | 0 (0/37) | 0 (0/23) | 2% (1/42) | – |
| ACOVE Pain Indicator: Medical Record Data | ||||
| 8. Percent of participants noted to have pain on the MDS assessment who have a pain assessment using a standard scale within two weeks of admission | 85 (23/27) | 78 (29/37) | 92 (11/12) | – |
| Pain Measures: Medical Record Data | ||||
| 9. Percent of participants who have chronic pain*** according to interview by research staff with documentation on the MDS assessment of moderate or excruciating pain less than daily or mild, moderate, or excruciating pain daily. | 33 (22/67) | 43 (34/79) | 22 (8/37) | |
| 10. Percent of participants with chronic pain according to interview by research staff who are offered ordered as needed pain medications on at least 50% of the days in the previous month | 8 (3/39) | 3 (1/35) | 6 (1/18) | – |
| Pain Measures: Participant Interview Data | ||||
| 11. Percent of participants with MDS recall score≥2 responding yes to “Does the nurse ask you about pain?” | 47 (66/140) | 45 (53/118) | 41 (22/54) | – |
*
P≤.05;
**
P≤.001;
***
Participants were judged as endorsing chronic pain if they responded yes to the question “Do you have pain every day?”or if they responded yes to three or more of the following interview questions about pain: “Do you have pain every day?”, “Does pain ever keep you from doing things you enjoy (like social activities, walking, going to the dining room for meals, knitting, bingo, going outside)?”, “Does pain ever keep you from sleeping at night?”, “Do you have pain right now?”.