Preventing Pressure Ulcers

CMS is continuing to place a high priority on pressure ulcer reduction.

During our 2008-2011 patient safety initiatives, Qualis Health will assist a group of local nursing homes and hospitals to develop and implement interventions to substantially lower the number of Idaho and Washington patients suffering from pressure ulcers.

As the project progresses, we will post status updates, lessons learned, and useful tools to this webpage. While our individualized consultation is limited to the participating organizations, any nursing home or hospital is welcome to use the tools posted here.

Please see the pressure ulcer prevention resources, below, developed specifically:

• For nursing homes
• For hospitals
• For use in both settings

Nursing Home Resources
Minimum Data Set (MDS) version 3.0
The final version of MDS 3.0 is scheduled to be published in October 2009, with implementation by October 2010. See the related details on the CMS website as well as a whitepaper from the American Association of Homes and Services for the Aging.

Change Package & Assessments
Based on the best practices of nursing homes across the country, these tools can help guide your facility's efforts to further reduce the incidence of pressure ulcers:

• Change package
• Facility-level assessment
• Resident-level assessment

Project's Quality Measure
Initially, nursing homes participating in the Pressure Ulcer Patient Safety Initiative will set improvement goals for the long-term high-risk resident population. See how this quality measure is calculated from the MDS 2.0.

Weekly Pressure Ulcer Log
All facilities participating in the Pressure Ulcer Patient Safety Initiative will need a tracking system to assess the ongoing effectiveness of their pressure ulcer prevention and treatment systems. You can use a weekly log to uncover trends such as the number of facility-acquired pressure ulcers or the effectiveness of treatment. Contact us to receive examples of weekly logs that you might modify to suit your purposes.

Individual Resident Record
Use this form to document a resident's pressure ulcer risk factors, causes, and treatment, as well as the characteristics (stage, site, size, drainage, and odor) of any existing wounds.

From Institutional to Individualized Care
The prevention of pressure ulcers and elimination of physical restraint usage are two topics covered in this informative four-part series. Practitioners discuss how they have refocused basic care-giving systems, including night-time care, activity and engagement, food service, bowel and bladder functioning, and turning and repositioning. More information.

Change Package
Use the best practices documented in this change package to guide your hospital's efforts to reduce facility-acquired pressure ulcers.

Resources Appropriate for Both Nursing Homes and Hospitals
Risk Assessment
Identifying high-risk residents can go a long way in preventing pressure ulcers from developing at all. Both of the following tools have been extensively tested for their effectiveness in quantifying pressure ulcer risk.

• Braden Scale for Predicting Pressure Sore Risk
• Norton Scale

Additional risk factors such as medications, diagnoses, cognitive impairment and behaviors such as smoking must be assessed. These additional risk factors increase a patient's susceptibility to develop pressure ulcers and impair healing.

• Checklist of risk factors and appropriate interventions

Reference Cards
These 4x6 reference cards provide photos for distinguishing pressure ulcers from other look-alike skin conditions, as well as concise guidelines related to pressure ulcer staging, classifying, and proper positioning.

Under Pressure! Nutrition Solutions For Pressure Ulcers
Presented 3/18/09 Download the presentation handout
Presenter: Becky Dorner, RD, LP
This presentation emphasizes the critical influence nutrition has on the development and treatment of pressure ulcers. It discusses the evidence related to medical nutrition therapy (MNT), shows you how to assess nutritional needs, and provides suggestions for the most effective nutrition interventions.

Strategies for Pressure Ulcer Prevention
Recorded 12/17/08   
Presenters: Katheen M. Borchert, MS; Jeri Lundgren, RN, CWS, CWCN; Sherrie Dornberger, RN, CDONA, FACDONA
This presentation featured a panel of experts representing hospital, nursing home, and patient perspectives. Recommended strategies for timely skin inspections and risk assessments were discussed.

Taking the Pressure Off: What You Can Do to Prevent Pressure Ulcers
Recorded 11/12/08   Help with WebEx files
Presenter: Joyce Black, PhD, RN, CPSN, CWCN
Learn how to target your interventions to prevent pressure ulcers. Understand what deep tissue injury is and how it compares to terminal ulcers.

Idaho & Washington Community of Practice Presentations
This webinar series is focused on sharing information—related to pressure ulcer prevention—among local hospitals and nursing homes.

Session #2, A Cooperative Approach
Recorded 2/3/09  
Presenter: Lynn Tungseth, Communities of Practice Coalition Member
The session explored the use of sub-scale risk assessments to prevent or reduce pressure ulcers.

Session #1, Engaging Your Community
Recorded 11/4/08  
Presenters: Sharon Eloranta, MD and Susan Hausmann, MS
Learn a simple method for engaging referring healthcare providers that will reduce the "blame game" and place the focus back on solutions.

Compilation of Tools Related to Pressure Ulcers
The QualityNet website, which is maintained by Medicare Quality Improvement Organizations (QIOs) nationwide, stores tools for nursing homes and as well as resources tailored to hospitals.