To receive the quality incentive point for this measure, not more than 5.73% of the facility's long-stay, high-risk residents may have been assessed as having one or more stage two, three or four pressure ulcers during the minimum data set assessment process. (The applicable percentage is based on CMS calculations using MDS 3.0. The applicable percentage was calculated so that approximately 50% of providers earn the point. See O.R.C. 5111.244(E) and (F) for details.)
The facility's MDS score will be verified. No reporting action by the facility is needed.
Health outcomes for nursing homes residents include reduction in pain and suffering, reduced risk of infection and sepsis, and Improved quality of life and dignity.
Outcomes also include savings to the health care system (wound care supplies and staff time to assess, document and treat wounds). "AHRQ estimates that the average pressure ulcer-related hospital stay extends to between 13 and 14 days and costs between $16,755 and $20,430, depending on medical circumstances." - "Positive Outcomes of Culture Change - The Case for Adoption," Tools for Change, vol.1, no 2, April 2011, the Pioneer Network
This measure also can improve survey performance (less margin for citation with fewer pressure ulcers) and satisfaction score improvement. Clinical practice, expert opinions and published literature indicate that most, but not all, pressure ulcers can be prevented (consensus statement from NPUAP
Achieving this measure maintains compliance with survey regulations, corporate monitoring systems and quality indicators and quality measures.
Reducing the number of pressure ulcers in high-risk residents requires a systemic approach to quality improvement:
- Implement clear protocols for risk assessment and skin inspection.
- Individualize care plans (with front-line staff input) based on identified risk areas.
- Implement clear protocols for risk assessment and skin inspection. Refer to these resources for help.
- Implement clear protocols for communicating care plans and risk status to front-line staff.
- Provide effective education for new staff; annual in-servicing and competency testing for nursing department.
- Increase use of consistent assignment and improved staff retention.
- Improve supervision and monitoring of hands-on care (e.g. turn schedules, incontinence care, etc.).
- Conduct root cause analysis of all facility-acquired pressure ulcers.
- Implement clear protocols for treatment of existing pressure ulcers.
Review policies and procedures. Involve staff in improvement efforts and individualized care planning. Focus on communication and interdisciplinary involvement.
Mentor nursing facility .
The Advancing Excellence in America's Nursing Homes campaign's materials on Pressure Ulcer Reduction (LINK: http://www.nhqualitycampaign.org/star_index.aspx?controls=pressureulcersexploregoal) includes an implementation guide, tool for tracking, webinars, fact sheets and more.
Pathway for Prediction, Prevention and Treatment of Pressure Ulcers in Nursing Homes, Ohio KePRO
Gauging Pressure Ulcers: A Nursing Home's Guide to Prevention and Treatment, Primaris
Reducing Pressure Ulcers in Nursing Homes: An Interdisciplinary Process Framework (Audio file), Advancing Excellence in America's Nursing Homes Campaign
Quick Reference Guide for Prevention, National Pressure Ulcer Advisory Panel (NPUAP)
A Handbook for Nurses, Chapter 12. Pressure Ulcers: A Patient Safety Issue, Agency for Healthcare Research & Quality Patient Safety and Quality
Pressure Points Poster, Ohio KePRO
Pressure Ulcer Staging, National Pressure Ulcer Advisory Panel (NPUAP)
Quick Reference Guides for and Treatment, National Pressure Ulcer Advisory Panel (NPUAP)
Pressure Ulcer Prevention Points, National Pressure Ulcer Advisory Panel (NPUAP)
Pressure Ulcer Scale for Healing (PUSH) Tool, National Pressure Ulcer Advisory Panel (NPUAP)
Skin Care Posters - Set I, Ohio KePRO
Skin Care Posters - Set II, Ohio KePRO
Skin Care Posters - Set III, Ohio KePRO
Skin Care Posters - Set IV, Ohio KePRO
Pressure Ulcer Quality Measure Poster, Ohio KePRO
Electronic PUSH Tool, Ohio KePRO
Pressure Ulcer-Free Calendar, Ohio KePRO
Pressure Ulcer Overview, Ohio KePRO
Positive Outcomes of Culture Change, The Pioneer Network
State Operations Manual Appendix PP, FTag 314, The Centers for Medicare & Medicaid Services.
NCHS Data Brief: Pressure Ulcers Among Nursing Home Residents, 2004, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics