Guide to the

Monthly Pressure Ulcer Tracking

Form

This material was developed and prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. ID number: 10SOW-NY-AIM7.2-11-09 (Version 3.1- October 2010)

Table of Contents

INTRODUCTION ..............................................................................................................................1

OPENING THE FILE.........................................................................................................................1

SECURITY SETTING IN EXCEL ......................................................................................................2

MONTHLY PRESSURE ULCER TRACKING FORM (with sample data)..........................................3

“AUTOMATED” FUNCTION BUTTONS............................................................................................4

Add New Case (“AUTOMATED” FUNCTION BUTTON)...................................................................5

Sort (Advanced) (“AUTOMATED” FUNCTION BUTTON)..............................................................7

Month End Routine (“AUTOMATED” FUNCTION BUTTON) .........................................................9

“INSTRUCTIONAL PAGE” SHEET.................................................................................................13

“STAGING INFORMATION” SHEET...............................................................................................14

“DATA SUMMARY SHEET”............................................................................................................15

PRESSURE ULCER WOUND STATUS .........................................................................................16

“CURRENT” STAGE or APPEARANCE .........................................................................................16

ABILITY FOR DETAILED COMMENTS..........................................................................................16

AUTOMATIC CALCULATIONS AND GRAPHING..........................................................................17

DATA “DRILL-DOWN” OPPORTUNITIES ......................................................................................17

SORTING BY LOCATION (Sample) ...............................................................................................18

“UNPROTECTING” THE PU DATA SHEET ...................................................................................19

DELETING ROWS TO “DRILL DOWN” DATA................................................................................20

SAMPLE GRAPH – ALL PTA (Prior to Admit) Pressure Ulcers by Site ..........................................21

“SAVE AS” Function to Manage Your Data.....................................................................................22

PU STATISTICAL TRENDING REPORT........................................................................................23

FOR ADDITIONAL INFORMATION................................................................................................23

INTRODUCTION

The “MONTHLY PRESSURE ULCER TRACKING FORM” was developed to assist facilities with a way to track their pressure ulcers on a monthly basis. It maintains an active list of all pressure ulcers and each wound’s current status in “real time”.

This guide will show you how to make the best use out of the Monthly Pressure Ulcer Tracking Form. This guide will also serve as a troubleshooting guide to assist you with common issues you may come upon.

The computer file is in an Excel format. However, many of the components of the file are “protected” in an effort to both maintain the functionality of the program and prevent unintended changes by a new user.

The process is simple. You open the file... saving it to your computer in its present form as a “MASTER” file that you may always return to in the event of any sort of data loss or unintended deletion on a user’s part.

Follow the instructions (There is an “Instructional Page” sheet tab for easy reference.) entering each pressure ulcer individually on the “PU Data Sheet”. Remember to pay attention to detail. The stage for an ulcer is the same across the row. DO NOT DOWN-STAGE or “Reverse-Stage”.

OPENING THE FILE

When you first open the file, you will get a pop-up message like the one displayed below. You must “enable” the macros in the file to take advantage of the “automated” functions such as “sorting” and the “End of Month Routine”.

You need to “click” on

this button

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SECURITY SETTING IN EXCEL

If you DO NOT see this pop-up message whenever you open the file, the worksheet will not function properly.

Your SECURITY SETTING in Excel cannot be set higher than “MEDIUM” to have the “automated functions” (macros) operate properly.

This is an example of a window accessed through your “tool” drop-down…. Under “macros” and “security”.

If you find that your security setting has to be changed, you will need to re-open the PU Tracking Form file (after you change your security settings) to see the required “pop-up” message to “enable macros”.

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MONTHLY PRESSURE ULCER TRACKING FORM (with sample data)

Below is a sample of what your screen would look like after data has been put into the spreadsheet.

These “tabs” at the bottom of the screen represent different worksheets within the file. Many are bar graphs to represent the information entered on

the “PU Data Sheet” worksheet.

Remember to be consistent when you enter the “stage #” in the various columns across the form. All of the stage #s should be the same across the row representing the initial stage of the pressure ulcer. DO NOT BACK-STAGE. Those entries automatically build the graphs for the various headings (i.e. PUs Acquired In-House, PTA, New Acquired In-House and PTAs for the Current Month...)

Use the weekly columns to effectively enter “status” code of each PU. (i.e. change / response to treatment) A status of “S” 2 weeks in a row or “W” indicates need for additional focus on wound.

Both the “Location Detail” and the “Comments” columns are free text... meaning you may utilize them for any purpose you feel may be helpful in your tracking.

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“AUTOMATED” FUNCTION BUTTONS

You will note that there are 3 “automated” choice buttons

at the top of the sheet displayed....

“Add New Case”, “Sort (Advanced)” and ”Month End Routine”.

All of these are explained in separate sections to follow.

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Add New Case (“AUTOMATED” FUNCTION BUTTON)

Choosing this button automatically brings you to the last row on your sheet to

enter a new case (wound).

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You may start entering data for a new case or pressure wound.

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Sort (Advanced) (“AUTOMATED” FUNCTION BUTTON)

Choosing this button bring a “pop up” with a variety of sorting option such as the one displayed below...

This “pop up” box offers you the sorting option with up to 3 combined choices.

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By clicking on the “drop down” arrow, you will see the options, by column, for your first sort.

You can combine sorting options to arrange your data

to best suit your needs.

The illustrated example shows an “initial sort” by

“Location and Unit”... and a “secondary sort” by Resident

Name.

This would rearrange your data by room number (or floor) and rearrange each

area alphabetically by resident name.

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Month End Routine (“AUTOMATED” FUNCTION BUTTON)

This is the process at the end of a completed month to remove both “healed” and “discharged” pressure ulcers from the end of the month report... leaving only the existing pressure ulcers to be carried over as the starting data for the new month.

By choosing this option, you will get a series of prompts to prepare the close of a month and the “carryover” of cases to a new month without

having to enter all of the baseline information

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This “pop up” appears to explain the Month End

Routine “process”...

Click on the “Start” button.

This “pop up” explains that you will be saving your

current data on the sheet. By

choosing “Next”, your

current file will be saved with

its current name (for the monthly data).

This “pop up” shows that your

current data (with the name)

has been saved.

Click the “Next” button.

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At this point, you will be asked to name your new file for the new

month. In this illustration, it shows that

a folder named Pressure Ulcer

Tracking was set up to house the monthly files of your pressure ulcer

tracking program.

Click on this button.

Enter the name of the new file... REMEMBER to “Save As” and rename the file for the new month. This spreadsheet now is prepared as the start of your “new” month.

The file name will appear in the upper right-hand corner of every sheet in the file. That includes all graphs. Consider naming the file such as Your Facility Name Month Year

(i.e. ABC Facility May 2009). Ultimately, you will build a group of files, each with its own identified graphs,

for each month tracked. Once you are comfortable with this process,

the sorting... tracking... and graphing possibilities are endless!

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Sample File Name

This is the last “pop up” you

will see confirming the

process.

Click on the “Close” button.

MAKE SURE THAT YOU CHANGE THE “DATE RANGE” IN YOUR NEW FILE TO

REFLECT THE NEW MONTH BEING TRACKED.

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“INSTRUCTIONAL PAGE” SHEET

This page is available at any time while working in the file. Just “click” on the sheet (or “tab”).

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“STAGING INFORMATION” SHEET

Staging Information (with references) is easily available. Just click on the “tab”.

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“DATA SUMMARY SHEET”

This is a sheet (or “tab”) within the workbook that is protected (or “locked”) and is automatically filled in as information is entered into the “PU Data Sheet”. All calculations

are automatic and that information is automatically carried over into the various bar graphs also included in the file (along the bottom of the screen... see additional sheets or “tabs”).

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PRESSURE ULCER WOUND STATUS

After your weekly wound rounds, you enter the status for each pressure ulcer under the appropriate “week” column utilizing the codes for “New”, “Improved”, “Same” , “Worsened” and “Healed”.

Be reminded that if a wound stays the “same” for 2 weeks in a row, or “worsens” in any particular week, you need to react to that wound response. “If a pressure ulcer fails to show some evidence of progress toward healing within 2-4 weeks, the pressure ulcer (including potential complications) and the resident’s overall clinical condition should be reassessed. Re-evaluation of the treatment plan including determining whether to continue or modify the current interventions is also indicated...” (Source- Guidance to Surveyors for Long Term Care Facilities, Appendix PP/483.25(c) Pressure Sores/Tag F-314, effective date: November 12, 2004)

In this section of the “PU Data Sheet”, you also have an option to enter a *PUSH score for Stage 3 or 4 pressure ulcers. If this option is chosen for those ulcers, monitoring the PUSH scores for “progress toward healing” (reference above) should be maintained.

(*Please note that it has been found that while there may be changes in a wound from weekto week, the actual PUSH score may not change.)

A quick glance at this section of the spreadsheet will provide both present status of each wound and a brief history, depending on information entered.

“CURRENT” STAGE or APPEARANCE

By utilizing this column to indicate the “current” stage or appearance of each wound, it is helpful to “tell a story” of each wound by comparing the current appearance to initial stage at onset.

ABILITY FOR DETAILED COMMENTS

There are 2 “free text” fields for each wound that you may use for any purpose you see fit.

The first is “Location Detail”. This may be used to differentiate “right” v. “left” or any other specific information you may want to detail.

The second “free text” field is under “Comments”. Use this field for any information that may be helpful to anyone reviewing this tracking form. Examples of use include adaptive equipment, treatment trials, consultation notes, etc.

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AUTOMATIC CALCULATIONS AND GRAPHING

As data is entered into the “PU Data Sheet”, a “Data Summary Sheet” is automatically calculated and several bar graphs are instantaneously built with the information. Both the “Summary” and the various bar graphs will provide instant visual tools for monitoring, communication and staff education.

DATA “DRILL-DOWN” OPPORTUNITIES

Once data is entered into the “PU Data Sheet”, there are many opportunities to drill-down or dissect your facility data.

Sample opportunities could include multiple files for each group of monthly data.

The monthly data may be sorted and isolated by floor (or unit) and “saved as” a separate name. All summary data and related graphs within that newly named separate file would only illustrate the isolated data appearing on the PU Data Sheet.... and the “name” of the file would appear as a header on every sheet, including the graphs.

Comparisons could be easily made on such focus areas as: “Acquired In-House Pressure Ulcers” by Unit/Floor “All Pressure Ulcers by Site” by Unit/Floor “Pressure Ulcers Prior to Admit” (PTA) by Unit/Floor “Healed PUs by Site” by Unit/Floor

These comparisons and “drill-downs” could prove to be invaluable in identifying or isolating opportunities for additional education, equipment/treatment needs, and the sharing of “successes” within your facility’s efforts in pressure ulcer treatment and prevention.

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SORTING BY LOCATION (Sample)

Sorting by “Location” allows you to manage your data for easy reference during “wound rounds”.

This option also allows you the potential to delete unwanted rows (See “Unprotecting” the PU Data Sheet / page 19). If, for example, you want to only see Location “B” data, if you delete all

rows but those containing data from Location “B”, all information including the data summary sheet and accompanying graphs would only reflect that limited sample.

By then naming that file as, for example, “ABC Facility Name – B”... all sheets would be labeled for clarification.

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“UNPROTECTING” THE PU DATA SHEET

As a default setting, the PU Data Sheet is protected. If you intend on deleted rows to isolate specific data, you need to first “unprotect” the sheet.

This is very simple.

While on the PU Data Sheet, (depending on the version of Excel you are running... Either go to “Tools” on the menu bar, choose “Protection”... and “Unprotect Sheet”... or go to the “Review” tab, and click on “unprotect sheet”. You will now be allowed to delete rows of your choosing and “drill down” your data for further refinement.

To “Unprotect” sheet, click on “Tools”, “Protection”, and “Unprotect Sheet” to allow you to delete rows.

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REMEMBER TO ALWAYS “SAVE” YOUR FACILITY-WIDE DATA PRIOR TO ANY DELETION... AND ONCE REFINED... DO NOT USE “SAVE”.... USE “SAVE AS” UNDER THE “FILE” DROPDOWN ON THE TOOLBAR... AND RE-NAME YOUR FILE TO REPRESENT YOUR REFINED DATA.

IF YOU CHOOSE “SAVE” IN ERROR, THE PROGRAM WILL OVER-WRITE YOUR FACILITY­WIDE DATA WITH YOUR REFINED DATA.

DELETING ROWS TO “DRILL DOWN” DATA

Once the information has been sorted by your choice (see “Sort (Advanced)” page 18), you would choose rows (by hi-lighting the row number) to “delete” and isolate only the data you wanted to leave on the PU Data Sheet. After hi-lighting the rows you intend to delete... go to the “Tools” area of the tool bar... choose “Protection”.... “Unprotect Sheet”. This step allows you to delete rows on the sheet and isolate only the data you want summarized and graphed.

REMEMBER TO USE “SAVE AS” UNDER THE “FILE” TOOLBAR AND RE-NAME YOUR FILE TO IDENTIFY YOUR DATA CLEARLY... AS YOU WANT IT IDENTIFIED ON THE HEADER OF EVERY SHEET AND GRAPH... (i.e. “January 2009 – First Floor Only”).

Choose rows to delete by clicking mouse on row “number” to the left. This will hi-light the entire row for deletion. You may then either “right-click” on your mouse and choose “delete”… or go to the “edit” dropdown on your

toolbar… and choose “delete”.

You must have the entire row hi-lighted to make sure all information is deleted.

SAMPLE GRAPH – ALL PTA (Prior to Admit) Pressure Ulcers by Site

This graph depicts ONLY the “Prior to Admit” pressure ulcers by specific site. This graph could be invaluable as an indication of a trend otherwise obscured in the overall data.

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“SAVE AS” Function to Manage Your Data

Make sure you utilize the “Save As” option while saving a file to make sure you are saving it with the proper name to indicate the content. After drilling down in your data, if you only use the “Save” option, your entire monthly database will be OVER-WRITTEN with your “reduced sample”… something you DO NOT want to do!

In this example (illustrated below...), all data in the “ALL Pressure Ulcers Acquired In-House by Site” graph as well as all of the accompanying summary sheet and graphs will represent ONLY the Location B. You can repeat the same routine for all floors or units within your facility.

It has been repeatedly found that by separating your facility-wide data into separate units or floors, individual unit “strengths” as well as “weaknesses” become apparent as a result of that comparison. The graphs (such as the one below) provide immediate visual feedback of these comparisons.

REMEMBER TO UTILIZE THE “SAVE AS” FUNCTION UNDER “FILE” and RENAME EACH NEW FILE WITH A SPECIFIC NAME OF YOUR CHOICE. The file name will appear as a “header” on all printouts of that file... i.e. “ABC Facility- First Floor”.

There are unlimited ways to sort, portray and save your monthly pressure ulcer tracking data.

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PU STATISTICAL TRENDING REPORT

There is an additional report available that has been developed to mirror the Data Summary Sheet statistics.

At the end of the month, you can enter your summarized “end of month” data under the specific monthly column and your monthly data will be graphed over an extended period of time. The one­time entry of the monthly data is very quick with the way the file has been designed.

This is a separate Excel file available on the www.ipro.org/nhqi website.

FOR ADDITIONAL INFORMATION

PLEASE CONTACT.....

David L. Johnson, NHA RAC-CT IPRO 20 Corporate Woods Blvd. Albany, NY 12211-2370 Telephone- 518.426.3300, x 116 Fax- 518.426.3418 E-Mail- djohnson@nyqio.sdps.org

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