Few computerized systems have been implemented and evaluated in nursing home systems. The purpose of this descriptive study is twofold: 1) assess the frequency of active alerts occurring in two nursing homes implementing an electronic health record (EHR) with a clinical decision support system; and 2) determine if clinical responses of health care workers are different when a clinical alert is active versus not active. A secondary analysis of de-identified data was performed to derive conclusions about use of alerts to monitor residents' skin conditions in the nursing homes. The percentage of residents who had active skin integrity alerts ranged from 8% to 52%. A total of 118 alerts were analyzed from 59 residents in the analysis of documented clinical responsiveness. No significant difference was found in clinical documentation for responses when alerts were active versus when alerts were not active (N=59, p=1.00).