Alert activity at the facility level
Initial daily queries of active alert data were evaluated to observe patterns at the facility level. The investigator assumed that there would be significant variability among daily alert frequencies based on the diversity of care delivered to residents, changes in chronic conditions, and complexity of care.15
However, contrarily, little to no variation in alert frequencies was noted during the analysis period in all three facilities.
In Facility A, during the first 10 days no active alerts or triggers were documented for dehydration, decline in condition, weight loss, or weight gain; conversely, on a consistent daily basis there were 136 constipation alerts, three skin integrity alerts, and 40 improvement in condition alerts. Similarly from day 21 of the fourth month to the last day of the sixth month, all alert counts were the same. From day 11 of the first month to day 20 of the fourth month, there was variable activity in all alert categories.
There was frequent variability in Facility B beginning day one of the first month and continuing to day 25 of the second month, when suddenly all daily alert totals for each category became consistently the same. In Facility C, total active daily alerts remained consistent during the entire six-month period of data collection. In facility C no active alerts occurred for the entire period for skin integrity, dehydration, or decline in condition. Consistently, daily active alert totals were 83 and 18 throughout the six months.
As a result, only active alerts and associated triggers from day 11 of the first month to day 20 of the fourth month in Facility A and day 1 of the first month to day 24 of the second month in Facility B were included in this analysis, for a total of 155 days of alert activity. Since no variability in the alerts was noticed in Facility C, data from that facility were not used. For more results and discussion of alert frequencies and potential reasons for these findings, see other studies by this investigator.16–18
The remainder of this section discusses the trigger frequencies associated with these active alerts and the types of resident diagnoses they were associated with.
Trigger frequencies by resident diagnosis
A total of 172 residents with eight primary diagnoses were included in this analysis (see tables –). The largest category (52 percent) included 89 residents who had ventilation pneumonitis as their primary diagnosis. These residents had nearly 17,000 triggers selected by the staff during the 155 clinical days considered in this evaluation (see Table ). The most frequent trigger within this category was related to the amount of food left uneaten, which resulted in an active dehydration alert. The proportion of food left uneaten was vigilantly documented by the staff; this trigger, which was associated with the dehydration alert, was in the top two of all triggers for every resident diagnosis. Its use ranged from 39.73 in residents with ventilation pneumonitis (Table ) to 21.92 percent in residents with osteoarthritis (Table ).
Residents with Ventilation Pneumonitis (89)
Residents with Osteoarthritis (7)
A large number of residents in the sample had neurological issues. Residents with Alzheimer's disease (Table ) represented 7.5 percent of cases. Dietary intake, continence, positioning, and emotional level were some of the most frequent triggers selected for this group of residents. Other important triggers, although selected less frequently in this class of residents, were the changing level of locomotion on and off the unit and the ability to walk in corridors.
Residents with Alzheimer's Disease (13)
Eighteen residents in this study had experienced cerebral vascular accidents (CVAs) (Table ). Amount eaten at meals (28.79 percent), urinary continence (21.58 percent), and hydration status (5.87 percent) were the most frequently selected triggers for residents with CVAs. Twenty residents with a dementia diagnosis (Table ) had 9263 triggers selected during the study period; 29 percent were for bladder incontinence, which related to the skin integrity alert. Bladder incontinence was also the most frequently selected trigger (26.89 percent) in residents with osteoarthritis (Table ). Bladder incontinence is another assessment parameter that seems to be monitored closely. Bladder incontinence was the second most frequent trigger selected in residents with Alzheimer's disease, hypertension, cerebral vascular accidents, pneumonia, and depressive disorders.
Residents with Cerebral Vascular Accident (18)
Residents with Dementia (20)
A smaller number of residents (seven) in this study were experiencing a depressive disorder (Table ). Again, dietary intake at meals and bladder incontinence were observed most frequently by the staff for residents with this diagnosis. The staff also documented other individualized assessments in this group of residents, including the ability to make decisions, performance of personal hygiene measures, and increased or decreased dressing, which all related to the clinical alert of improvement or decline in condition.
Residents with Depressive Disorder (7)
A wider range of assessments were selected by the staff for the 11 residents who had a primary diagnosis of hypertension (Table ). Although the majority of the triggers indicated that residents left their meals uneaten and were incontinent, other important information documented for these residents included locomotion, walking and transferring activities, changes in behavioral symptoms, amount of toilet use, and ability to make decisions.
Residents with Hypertension (11)
The most frequent triggers selected in the residents with osteoarthritis were related to bladder and bowel incontinence, the maintenance of turning and repositioning programs, and mobility (Table ). Emotional levels, personal hygiene, and ability to make decisions were also part of these residents' individualized assessments.
For the residents with pneumonia (Table ), dietary intake, continence, mobility, and maintenance of proper positioning accounted for the majority of computerized triggers selected. Less frequently, assessments regarding changes in their overall condition and self-care abilities were documented.
The percentages of weight gain and weight loss were documented less frequently for residents under each diagnosis. Weight loss and gain was documented in the system as a percentage of total weight. Weight loss of 3.5 percent of the resident's total body weight over 30 days or 7 percent over 180 days resulted in an active alert. Weight gain of greater than 3.5 percent of the resident's total body weight over 30 days or 7 percent over 180 days resulted in an active alert.