Case studies of IT sophistication in nursing homes: A mixed method approach to examine communication strategies about pressure ulcer prevention practices

Most nursing homes lack information technology (IT) for supporting clinical work in spite of its potential to improve the safety, quality, and efficiency of nursing home care in the United States. Increased attention to medical error and concern for patient safety have prompted general recommendations to develop sophisticated technologies to support clinical decision making at the point of care, to promote data standards in electronic records, and to develop systems that communicate with each other. However, little is known about what IT applications best support communication and risk assessment practices to improve resident outcomes in nursing homes. Thus, the overall aim of this study was to evaluate how differences in IT sophistication in nursing homes impact communication and use of technology related to skin care and pressure ulcers. We used a mixed method approach to conduct case studies on two nursing homes - one with high IT sophistication and one with low IT sophistication. Observational analysis and social network analysis were used to identify patterns in communication types and locations; also, focus groups were conducted to explore communication strategies used by Certified Nursing Assistants (CNAs) to support pressure ulcer prevention practices. Overall, results from social network analysis of observational data indicate that direct interactions between CNAs and registered nurses (RNs) or licensed practical nurses (LPNs) were more frequent in the low IT sophistication home and occurred in more centralized locations (e.g. the nursing station) compared to the high IT sophistication home. Moreover, these findings are supported by focus group results, which indicate that the high IT sophistication home had more robust and integrated communication strategies (both IT and non IT) that may allow for interactions throughout the facility and require less frequent face to face interactions between CNAs and RNs or LPNs to verify orders or report patient status. Results from this study provide insight into the design and assessment of different forms of communication to support clinical work in NHs. Relevance to industry: Nurses bear great burdens for nursing home care; yet, issues persist with poor quality, variable performance of caregiving, and lack of implementation of proven care interventions. One new hope for improvement in nursing home care is the introduction of IT to improve communication, clinical decision-making, and quality of care.