Documentation of patient repositioning events: Comparison of Electronic Medical Record documentation and accelerometer-based wearable sensors

INTRODUCTION 
Repositioning documentation serves an important function for pressure injury root cause analysis[i], managing pressure injury (PrI) prevention programs and for litigation defense[ii]. While many data-points such as vital signs and labs are automatically populated in the Electronic Medical Record, patient repositioning is still documented manually and often at the end of the shift. 
This study sought to understand differences in repositioning documentation using traditional manual methods vs. automated documentation from accelerometer-based wearable sensors.

METHODS
Repositioning documentation was analyzed retrospectively on random convenience-sample of 30 Telemetry and Surgical patients in February 2020 with Q2h turn protocol. Patients with pre-existing PrI, BMI< 14, expected stay >48 hours or those unable to turn themselves were assigned sensors which provided visual turn reminders and automatically documents all repositioning events.  Staff was exempt from documenting turns for patients with sensors but required to manually document turns for all others. 
Documentation was compared for patients with and without sensors. For the sensor group, documented positions ≥15 minutes were counted for each complete 12-hour shift.  For the manual documentation group, repositioning events per complete shift were counted, including transfers from bed to chair and ambulation events.  

RESULTS
In the sensor group, mean number of turns was 4.6 per shift (min 3, max 11). Mean time between turns was 2.6 hours. In the manual group, mean number of turns was 0.5 per shift (min 0, max 5). Five patients had no turning documentation. Mean time between turns was 28.75 hours.  Patient’s new position/orientation was documented 100% in the sensor group, and 0% in the manual group.  

CONCLUSIONS
Repositioning events are documented significantly more frequently by wearable sensors than manual methods. Sensor-based documentation may offer a more complete history of patient’s mobility to assist in root cause analysis or when auditing patient care.

Trademarked Items (if applicable):

References (if applicable): [i] National Pressure Injury Advisory Panel. Root Cause Analysis Toolkit. 2020. https://npiap.com/page/RCAToolkit
[ii] Genesio, J. Pressure Ulcers Are Easy Pickings For Lawsuits. A long-term care center should regularly train and re-train staff on wound care, emphasizing the importance of documentation. Provider Long Term Care & Post-Acute Care. April 2016