Exploratory Study of Nursing Home Factors Associated with Successful Implementation of Clinical Decision Support Tools for Pressure Ulcer Prevention

Objectives: To determine those factors that are associated with nursing homes' success in implementing the On-Time quality improvement (QI) for pressure ulcer prevention program and integrating health information technology (HIT) tools into practice at the unit level.

Design: Observational study with quantitative analysis of nursing home characteristics, team participation levels, and implementation milestones collected as part of a QI program.

Setting: Fourteen nursing homes in Washington, District of Columbia, participating in the On-Time Pressure Ulcer Prevention program.

Main Outcome Measures: The nursing home level of implementation was measured by counting the number of implementation milestones achieved after at least 9 months of implementation effort.

Main Results: After at least 9 months of implementation effort, 36% of the nursing homes achieved level III, a high level of implementation, of the On-Time QI-HIT program. Factors significantly associated with high implementation were high level of involvement from the administrator or director of nursing, high level of nurse manager participation, presence of in-house dietitian, high level of participation of staff educator and QI personnel, presence of an internal champion, and team's openness to redesign. One factor that was identified as a barrier to high level of implementation was higher numbers of health inspection deficiencies per bed.

Conclusion: The learning from On-Time QI offers several lessons associated with facility factors that contribute to high level of implementation of a QI-HIT program in a nursing home.