Increasing documentation efficiency using wearable sensors for pressure injury prevention: A quality improvement project

INTRODUCTION: Nursing documentation provides an overwhelming burden to bedside clinical nurses. Nurses are required to manually enter several hundred data points into Electronic Health Record (EHR) flowsheets (Collins 2018), taking time away from direct patient care and introducing opportunity for documentation errors. While many medical devices such as vital signs monitors feed data directly to EHR, nursing activities like repositioning for pressure injury (PrI) prevention depend on manual flowsheet documentation. AIMS. This quality improvement initiative analyzed differences in EHR repositioning documentation in hospitalized patients using traditional, manual flow sheet documentation methods and vs. automated documentation using a wearable sensor system. 

METHODS: Repositioning documentation was analyzed on a convenience-sample of 68 hospitalized patients on Q2h turn protocol. Patients with pre-existing PrI, Braden Scale Score 48 hours or those unable to turn themselves were assigned a wearable sensor which provides visual turn reminders and automatically documents all repositioning events.  Staff are exempt from documenting turns for patients with sensors but must document turns in nursing flow sheet for all others.  

RESULTS: The sensor group mean number of documented repositioning events per 12-hour shift was 4.6, with mean time between turns (MTBT) 2.6 hours. In the manual group, mean number of repositioning events was 1.8 per shift with MTBT of 6.6 hours (pSensor-based cueing technology holds promise to reduce nursing documentation burden and provide a more complete history of patient’s mobility in EHR.