1108 — Preventing Community Acquired Pressure Injuries in Spinal Cord Injury Using a Decision Support Tool in the SCI Clinic
Lead/Presenter: Lisa Burkhart,
COIN - Hines
All Authors: Burkhart LE (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital), Smith A (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital) Lavela S (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital) Osteen C (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital) Bartle B (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital) Weaver F (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital)
Describe how the Community Acquired Pressure Injury Prevention Field Implementation Tool (CAPP-FIT) decision support tool may prevent community-acquired pressure injuries (CAPrIs) among Veterans living with spinal cord injury (SCI) in the SCI clinic.
The CAPP-FIT was grounded in qualitative research with Veterans with SCI and SCI providers and validated using a Delphi expert panel of 4 Veterans living with SCI, 3 caregivers, and 15 interprofessional healthcare providers. The CAPP-FIT is used prior to an established SCI clinic visit and includes: 1) a Veteran survey to identify risks, actions, and resources needed to prevent CAPrIs (programmed on an iPad app), and 2) a companion Provider Report immediately available listing Veteran responses to survey items identifying CAPrI risks with recommended evidence-based provider actions. The CAPP-FIT was piloted at one SCI Clinic for up to 6 clinic visits per participant. Veteran-identified risks were summarized. Chart review revealed use of evidence-based provider actions to address identified risks. Veteran satisfaction with the CAPP-FIT was measured with the Mobile App Rating Scale. Providers evaluate implementation during monthly meetings. CAPrI incidence is measured 6-months post initial CAPP-FIT implementation.
Seven providers are participating in the pilot. Out of the initial 63 Veteran participants, 98% identified required care needs associated with CAPrI risk factors. The most common risks identified at the initial CAPP-FIT implementation were an acute illness that affects CAPrI prevention (73%), mobility/activity issues (63%), and substance issues (54%). The CAPP-FIT stimulated provider interventions for 48% of Veteran-identified risks. Preliminary results of CAPrI incidence showed a decrease from an average of 27.4% in FY18-FY21 at the pilot site to 18% following 6 months post CAPP-FIT implementation. Almost all Veteran participants agreed the questions were relevant to the challenges they experience (94%) and indicated the CAPP-FIT made it easier to have conversations with their provider (94%). Veterans felt most providers discussed the risk factors identified in the CAPP-FIT (86%). During monthly meetings, providers agreed that the CAPP-FIT changed their practice to incorporate more community-focused preventive care questions and identified issues that would have gone unnoticed.
Results indicate the CAPP-FIT reveals CAPrI risks and improves provider preventive care. It also improves communication between Veterans and providers and decreases the incidence of CAPrIs.
Persons with SCI are at high risk for pressure injuries, with 95% experiencing one severe pressure injury during their lifetime. CAPrIs cost the VA more than $89 million annually. The CAPP-FIT has the potential to improve preventive care, facilitate provider-Veteran communication, and decrease the incidence and costs of CAPrIs.