Nursing Home Quality Improvement Initiative
Quality Measure Fact Sheet:
Percent of Chronic/Long Term Care High-Risk Residents with Pressure Sores
What this means:
This measure reflects the percent of chronic/long term care high risk residents who have one or more pressure sores. High risk residents are those who are impaired in bed mobility or transfer, comatose, and/or are malnourished. Pressure sores, also called pressure ulcers, are areas of injured skin and tissue that often develop over the bony parts of the body, such as the tailbone, hip, ankle, or heel. They may be caused by constant pressure on one part of the skin from chairs, wheelchairs, or beds.
But pressure is just one of many factors determining skin condition or affecting skin breakdown. Residents most at risk for the development of pressures ulcers are those who are emaciated, obese, immobilized (such as being confined to bed or chair), and those who have diabetes or some type of circulatory disorder. Incontinent residents are at risk, as urine and feces contribute to skin breakdown. Pressure sores may be painful, take a long time to heal, and cause other complications such as skin and bone infections.
Why residents may have pressure sores despite receiving good care:
Long term care facilities can do several things to help prevent or treat pressure sores, such as frequently changing the resident's position, using soft padding to reduce pressure on the skin, and providing proper nutrition.
Despite receiving good care, some residents may develop pressure sores and/or some sores may not heal. There are many illnesses that negatively affect skin condition. Individuals who have multiple illnesses and/or other conditions such as incontinence, dehydration, poor hygiene, weight loss, decreased level of consciousness, and poor mobility are more likely to develop and have trouble healing pressures sores.
In general, the risk of skin breakdown is greater in individuals with more underlying illnesses and conditions noted above. Many of these conditions may not improve, and some usually worsen near end of life. Some residents may refuse treatment or not cooperate with a treatment regime. Even the most vigilant nursing care may not prevent development and worsening of ulcers in very high risk individuals.
What conditions exclude a resident from this measure: (Risk adjustment)
No conditions are excluded from this measure.
| Questions you can ask the facility if they are rated high in this measure:
- How many residents with pressure sores were admitted with the sores?
- What percent of residents with pressure sores are high risk residents (impaired mobility or transfer, comatose, or malnourished)?
- How many residents with pressure sores have a terminal illness?
- How does the facility assess residents for risk factors for developing pressure sores?
- How often does the facility assess residents for skin breakdown or pressure ulcers?
- How does the facility try to prevent pressure ulcers, especially when dealing with high risk patients?
- Does the facility have a wound care program, and how does it work?
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