Implementing a visual cueing technology intervention in a nursing home: Nursing staff perceptions

The development of a pressure ulcer/injury (PrU) poses a significant health risk for older adults, especially individuals with mobility deficits or cognitive deficits that may limit their ability to move,1 thus placing them at greater risk for PrU development. A PrU, is defined as an area of localized tissue damage that is caused by unrelieved pressure, friction, or shearing force on any part of the body.2,3 PrUs for the most part are preventable healthcare-acquired condition, and older adults receiving care in a nursing home (NH) have almost double the risk of development compared to hospitalized patients,4 with at least one of every nine NH residents experiencing a PrU in the United States.5,6 Advanced practice registered nurses (APRNs), with their additional education and training, are well-positioned to assess their NH work environment for areas needing practice improvement and subsequently lead nursing staff teams to improve care outcomes such as prevention of PrU development.7 Many NHs have high incidence and prevalence rates, in some instances well over 20%.8–10 The cost of treating PrUs is estimated to range from $21,000$152,000 per PrU,11 costing US healthcare systems 11 billion dollars a year.12 Effective prevention can reduce PrU incidence and avoid treatment costs while improving resident satisfaction, safety, and quality of life.13 Resident repositioning by nursing staff is the hallmark of PrU prevention care. However, repositioning a resident on a schedule (every two hours is the standard of care3) is a task that must be completed at a specific time (time-based task); nurses perceive time-based tasks as more challenging to manage than eventbased tasks because of their reliance on memory.14 Repositioning is a repetitive task that requires a high degree of on-time compliance,13 further complicating the delivery of PrU prevention care by NH nursing staff. Furthermore, repositioning protocol compliance is self-reported and charted when convenient, often at the end of a shift, making determination of actual compliance rates a challenge. There is an opportunity for APRNs to facilitate PrU prevention care by introducing frontline staff to technological innovations, such as equipment that can visually cue staff when a repositioning is required, thus increasing compliance with this timebased task.15 Our project examined nursing staff repositioning compliance as part of an ongoing clinical trial (NCT02996331) aimed at determining safe repositioning intervals. The Leaf Patient Monitoring System (LPMS) was used to tracked NH resident movement and position and then displayed the results for all nursing staff to see who was due for repositioning. This system was in place for a 4-week period at a 176-bed NH in the Northeast United States. The PrU prevention protocol required the use of visco-elastic (VE) mattresses, appropriately sized wheelchairs, skin care supplies, incontinence briefs, and the appropriate number of pillows for proper repositioning. Residents were located on three units in the NH. The LPMS technology is a wireless triaxial accelerometer sensor that is put on the resident’s upper torso and tracks a resident’s position in real time, thus reducing nursing staff reliance on memory for next position change. The LPMS resets the countdown when an adequate 20-degree change in position while flat or a 10-degree tilt in an upright position is achieved allowing pressure offloading, either by the nursing staff or independently by the resident. Furthermore, this technology has an electronic time stamp of when the movement occurred, thus decreasing the time nursing staff devote to charting. The Leaf sensor collected real-time data and offered real-time visual cue feedback related to resident movement and need for position change. The sensor uses LCD screens mounted in hallways and at nursing stations to display visual cues for nursing staff related to resident movement and need for position change. Visual cues, much like what is shown on the LPMS LCD screens, help staff to remember tasks, initiate tasks at the right time and decrease the frequency of forgotten tasks.15 All nursing staff received a mandatory pre-implementation 50-minute educational in-service that GAPNA section – October 2018 issue of GN. Funding: This work was supported by the National Institute of Nursing Research (NINR). Grant number: NCT02996331. * Corresponding author. E-mail address: Ijeoma.anen@duke.edu (I.A. Ifedili).