Quantitative Validation of the Impact on Reducing Pressure Ulcers/Injuries in Skilled Nursing Facilities Using a Smartphone App

Background: Pressure ulcers / injuries are a major problem for residents of skilled-nursing facilities (VanGilder, 2017). They are a key metric for quality of care and are not reimbursed by the Centers of Medicare and Medicaid in the US. Current standard of care for wound assessment is paper-based documentation while wound photography is not mandatory (Haesler, 2014). A digital wound care management solution enables clinical practitioners to photograph, measure and document wounds at the point of care (Wang, 2017). This information is uploaded into cloud-based servers, allowing analysis of this information to be used to monitor quality improvement at the population level. Improvements in pressure ulcer prevalence has been demonstrated by using a combination of quality improvement processes and a smartphone app. (Au, 2018, Under Review).

Methods: We conducted a retrospective study comparing the pressure ulcer prevalence in facilities using the Skin and Wound app (n=500) with facilities using traditional method, real-world data from the Centers of Medicare and Medicaid, one year pre and post implementation. Specifically, the quality metric outcome of pressure ulcer prevalence was analyzed.

 Results: Facilities that adopted Skin and Wound showed a reduction in pressure ulcers at time of implementation for both long- and short-stay residents. This trend continued each quarter from adoption.

Conclusion: 

We demonstrate that:

1. Adoption of a digital wound care management platform can be used to help reduce the prevalence of pressure ulcers in the context of skilled nursing facilities.
2. Real-time measures on the wound-related metrics are important in quality improvement.
3. Further awareness and training of the app and real-time monitoring of pressure ulcers may lead to greater quality improvement in skilled nursing facilities.