Pressure Ulcers

Pressure ulcers, also called pressure sores, are skin wounds that usually develop on bony parts of the body. They may be painful and take a long time to heal or cause other complications like skin and bone infections. Pressure ulcers occur across health care settings and are often preventable. The elderly are at greater risk of developing pressure ulcers due to age-related skin changes. Some of these factors include immobility, incontinence, inadequate diet, chronic illness, altered level of consciousness, altered sensory perception, and prior history of pressure ulcers. Preventing pressure ulcers is the best treatment.

Current work with pressure ulcers

Stratis Health has worked with nursing homes to improve skin care since 2002. Stratis Health, in partnership with Minnesota Department of Health and others, offers educational training sessions, collaborative learning opportunities, and resources to provide training to all nursing homes in the state. In the most recent data available, there was a 1.7 percent decrease in the pressure ulcer rate for high-risk patients. This is a statistically significant improvement.

Stratis Health currently works with a group of Minnesota nursing homes as part of the Centers for Medicare & Medicaid Services National Patient Safety Initiative. The group will focus on improving pressure ulcers. Training and resources on topics such as, person-centered care, nutrition, falls, and mobility are available to the group. Stratis Health is leading a series of collaborative learning sessions for the group.

Resources

Advancing Excellence in America’s Nursing Homes. A coalition-based campaign working to improve the quality of care and quality of life for those living or recuperating in America's nursing homes. The site contains resources on pressure ulcers, including an updated pressure ulcer tracking tool (5-worksheet Excel doc), as well as other topics.

Clinical Web Window. Minnesota Department of Health Compliance Monitoring Division will provide alerts for providers to new clinical issues that may affect survey trends, standards for compliance continue to be based on the existing state and federal regulations.

Coding Suspected Deep Tissue Injury. Recommendation on MDS 3.0 from the National Pressure Ulcer Advisory Panel. (1-page PDF)

ConsultGeriRN.org. Nursing Standard of practice protocol: Pressure ulcer and skin tear prevention.

Educational Recorded Webinar sessions. Sponsored by Stratis Health, available on a variety of topics, e.g., clinical topics, quality improvement, organizational change, using data, staff and resident satisfaction, etc. Sort by topic, date, or setting.

Evidence to Practice. E2P is a online resource designed to provide access to ranked evidence and evidence-based strategies for managing care in a variety of important areas, including pressure ulcers.

Medline University. Two free online programs, one CEU credit each, Breaking Through Hand Hygiene and Skin Care Barriers and Skin Tears: New Approaches in Prevention.

Meet Me at the Skin Care Fair training module. A pressure ulcer prevention in-service with hands on activities. Each activity of the in-service covers one of the Braden Scale risk factors for pressure ulcers. The module is designed for nursing assistants and direct care staff and this session is meant to be used as a train-the-trainer activity for nurses.

The New International Guideline: Prevention and Treatment of Pressure Ulcers. Developed by the American National Pressure Ulcer Advisory Panel) and the European Pressure Ulcer Advisory Panel ), has now been released.

Note: Many long-term care providers wonder how the guideline affects F-314 and practice within a long-term care facility. CMS has not made comments or recommendations regarding these guidelines. Long-term care providers should continue to follow and comply with the guidance contained with F-314. This Pressure Ulcer International Guideline (2-page Word doc) document was reprinted and shared with permission from Jeri A. Lundgren and Pathway Health Services.

No More Pressure Ulcers poster. Best practices for pressure ulcer reduction. (1-page PDF)

Patient Safety: A Disparities Analysis of Quality Measures. The CMS Health Disparities Quality Improvement Organization Support Center report includes summary information regarding Minnesota residents with pressure ulcers and/or physical restraints. (15-page Word doc) Highlights > (2-page Word doc)

Pressure Ulcer Change Package. A tool for nursing homes to help prevent pressure ulcers. (9-page PDF)

Pressure Ulcer Dashboard (15-worksheet Excel doc). Tools for nursing homes to learn how to do better internal monitoring of issues. They may be useful during the interim without QI/QM reports. Sample Dashboard (15-worksheet Excel doc)

Pressure Ulcer Quality Resources Kit. This pressure ulcer management tool kit is designed to outline process steps and methodology that leads to improvement in preventing and managing pressure ulcers. (90-page PDF)

Pressure Ulcer Staging Guidelines. The National Pressure Ulcer Advisory Panel redefinition of a pressure ulcer and the stages of pressure ulcers. (2-page PDF)

Safe Oklahoma's Skin Toolkit for Pressure Ulcer Prevention and Treatment. A toolkit outlining a systems approach to quality improvement for skin care. The following are the main content areas covered in the kit:

1. Organizational Commitment and Policies for Pressure Ulcer Prevention and Treatment
2. Screening, Assessing, and Monitoring Pressure Ulcers
3. Prevention and Treatment of Pressure Ulcers
4. Care Planning for Pressure Ulcers
5. Staff, Family and Patient/Resident Education
6. Transitions of Care

Safe Skin Call to Action. Minnesota Hospital Association's SAFE SKIN initiative aimed at preventing serious pressure ulcers in hospital patients.

Success Stories booklet. This compilation of articles is based on successes of nursing homes in eliminating or reducing pressure ulcers and physical restraints and can serve as inspiration and resources for others.

Contact

Please contact Kelly O'Neill, Kristi Wergin, or Jill Kieser-Andersen for more information on Stratis Health's work and resources available.