Care monitor system to facilitate pressure ulcer prevention for the elderly

描述(由申请人提供)：为了减少压疮的发生率，长期护理机构的管理者必须确定哪些护理流程需要改进，并衡量他们的管理干预是否有效。目前，这是困难的，因为病人病历和医疗记录中高估了护理提供的可靠性。机构中患病或虚弱的老年人的大部分身体护理--特别是长期护理--由护理助理和其他临床辅助专业人员提供。这些助手工作量大，工资往往不高，因此工作流失率很高。对于临床管理来说，监测助手提供护理的可靠性并不容易，因为大部分护理是在病人房间的隐私中进行的，在那里很难衡量实际接受的护理的及时性和持续时间。对于痴呆症患者来说，遗漏护理尤其成问题，因为许多人无法识别或可靠地报告他们接受的护理不足或遗漏了护理。我们正在开发一种系统，以便在不增加护理助理和其他直接护理临床人员的工作负担的情况下，方便和有力地监测身体护理的及时性。在SBIR第一阶段，我们将使用一个非常小、可靠和低成本的可穿戴体位监测器，患者可以佩戴它来不引人注目地记录各种关键的身体护理。因为我们记录病人经历的护理，所以它补充了基于护理助理自我报告的医疗记录。有证据表明，这种自我报告--无论是在纸质记录上还是在新的电子系统上--高估了实际提供给患者的护理。我们SBIR系统开发的重点是以临床管理和护理质量保证人员希望的方式，自动记录65岁以上有行动障碍、大小便失禁和可能患有痴呆症的人的老年护理质量，以提高设施护理质量。与公共卫生相关：长期护理机构的临床管理人员要监测由助手和助手直接提供的身体护理的可靠性并非易事，因为大部分护理都是在患者房间的隐私中进行的。如果接受护理的患者患有痴呆症，并且不能可靠地报告护理缺陷，情况尤其如此。我们现正发展一套系统，方便和有力地监察为老年病人提供的身体护理的种类、时间和持续时间，而不会增加护理助理和其他直接护理人员的工作负担。对于第一阶段，我们检查大小便失禁和压疮预防的重新定位护理。来自我们基于可穿戴显示器的数据收集系统的数据将以一种可用于促进临床质量保证和质量改进计划的形式使用。

DESCRIPTION (provided by applicant): To reduce the incidence of pressure ulcers, administrators of long term care facilities must identify which care processes need improvement and measure if their management interventions are effective. Currently, this is difficult because the reliability of care delivery is overestimated in patients' charts and medical records. Most of the physical body care of the ill or frail elderly in institutions - especially long term care - is provided by nursing aides and other clinical paraprofessionals. These aides have large workloads, are not often paid well and, hence, have high job turnover rates. It is not easy for clinical management to monitor the reliability of care delivery by aides and since much of the care is done in the privacy of a patient's room where it is difficult to measure the timeliness and duration of care that is actually received. Omitted care is especially problematic for patients with dementia, because many cannot recognize or reliably report when they receive poor care or care is omitted. We are developing a system to conveniently and robustly monitor the timeliness of body care delivery without increasing the work burden of nursing aides and other direct care clinical personnel. During SBIR Phase I we will use a very small, reliable, and low cost wearable body position monitor that can be worn by patients to unobtrusively record various critical kinds of body care. Because we record the care as it is experienced by patients, it supplements medical records based a nursing aides self reporting. There is evidence that such self reporting - whether on paper records or new electronic systems - overestimates the care actually delivered to patients. The focus of our SBIR system development is to automatically document the quality of geriatric care for people over 65 who have mobility impairments, incontinence , and may have dementia, in a manner desired by clinical management and care quality assurance personnel to improve facility care quality. PUBLIC HEALTH RELEVANCE: It is not easy for clinical management in long term care facilities to monitor the reliability of physical body care delivered directly by aides and assistants because much of that care is done in the privacy of a patient's room. This is especially true if the patient receiving the care has dementia and cannot reliably report on care deficiencies. We are developing a system to conveniently and robustly monitor the type, timeliness and duration of physical body care delivered to geriatric patients, without increasing the work burden of nursing aides and other direct care personnel. For Phase I we examine incontinence and repositioning care for pressure ulcer prevention. The data from our wearable monitor based data collection system will be in a form that can be used to facilitate clinical quality assurance and quality improvement programs.