Recently a colleague sent me a link to “Preventing Pressure Ulcers in Hospitals, A Tool Kit for Improving Quality of Care,” from the Agency for Healthcare Research and Quality. It's the latest “how-to” manual designed to help wound care providers improve pressure ulcer prevention. It didn't contain anything really new. It would seem not much has changed in the 16 years since the original AHCPR Pressure Ulcer Guidelines were published. But as I read it three things struck me:

1.     Almost one-third of the manual is devoted to the challenge of change management, not clinical management of wounds.

2.     It provides of plethora of  “tools” (i.e. paper forms) to help nurses monitor performance and track wound outcomes manually.

3.     There is no mention of the use of technology as a tool to enable nurses to achieve better outcomes in less time.

Chapter headings and sub-headings in the AHRQ Tool Kit reveal the daunting challenge providers face when taking on quality improvement: “Are we ready for this change?”  “Do organizational members understand why change is needed?” “Is there a sense of urgency?” “How will we manage change?” “What if we're not ready?” 

This begs the question, why should nurses object to changes that improve quality?

AHRQ's “tools” (i.e. paper forms) for monitoring clinical performance are modest: a one page Unit Log to summarize daily skin assessments and a two-page spreadsheet to review key processes of care. Most wound nurses could complete them in less than an hour or two. That's a snap compared to the “tools” Ohio KePro pushed out last fall. These include a complex Pressure Ulcer Dashboard and a PUSH Tool spreadsheet. Each requires the wound nurse to enter numerous values into detailed Excel spreadsheets, “after you complete your weekly pressure ulcer assessments.” I don't know any wound nurses who have so much extra time they need more forms to fill out.  Do you?

Ohio KePro distributed the Excel “tools” in their fall newsletter under the headline, “High Quality on a Limited Budget.” Remarkably the newsletter states, “While technology can definitely be a boon to quality improvement,  it's important to keep in mind that some low-tech, low cost solutions can also be effective…even in this digital age.”  You think?

Getting back to the question, why should nurses object to changes that improve quality?  Perhaps it has to do with bureaucrats who believe nurses have a lot of free time and that their time is free.

Anne Scheurich, RN, BS, CWOCN is the Director of Clinical Services at Telemedicine Solutions/WoundRounds.