News Room

Physical Restraints and Pressure Ulcers in New Mexico Nursing Homes:

Are Certain Groups of Residents More Likely to Have Them?

The New Mexico Medical Review Association (NMMRA), the Medicare Quality Improvement Organization (QIO) for New Mexico, recently evaluated pressure ulcer and physical restraint rates among New Mexico nursing home residents, examining specifically if the type of nursing home ownership, its location in a rural vs. urban setting, or resident ethnicity or gender make a difference in the rates found.

Restraints should only be used when they are necessary as part of the treatment of a nursing home resident’s medical condition. Only a doctor can order a restraint. In New Mexico, about 3.6 percent of residents have physical restraints. Pressure ulcers can generally be found between 12 percent and 13 percent of New Mexico nursing home residents with as many as 60 percent of residents at risk for developing one. According to a 2009 National Center for Health Statistics (NCHS) report, residents aged 64 years and under were more likely than older residents to have pressure ulcers (14% and 10%, respectively), and pressure ulcers are more common in males (13%) than in females (10%). Residents in nursing homes for one year or less (16%) were more likely to have pressure ulcers than those with a longer length of stay (7%).

The results of NMMRA’s analysis found no evidence of any significant differences in physical restraint rates for any of the various groups compared. However, NMMRA did find evidence of differences between the groups studied for risk of developing pressure ulcers. For example, male nursing home residents at high risk for pressure ulcers have a significantly higher pressure ulcer rate than females, while Blacks (not of Hispanic origin) and Native Americans have the highest pressure ulcer rates among the ethnicities studied.

“While statistically significant,” says Carlene Brown, MPH, CPHQ, NMMRA director of patient safety, “the apparent disparity between pressure ulcer rates for male and female residents at high risk for pressure ulcers is compatible with findings of other such national studies.”

NMMRA also found that Native Americans and Hispanics are generally underrepresented in nursing home populations when compared to the general population of the state (by 21.6% and 31.9%, respectively). Other non-White ethnicities, like Blacks and Asians, are also underrepresented, but the overall percentage of these ethnicities in the population is very small. NMMRA found that the lowest pressure ulcer rates were among Hispanics. While Hispanics are considered a minority population in most other states, their numbers are nearly equal to Whites in New Mexico.

NMMRA obtained data for the 71 New Mexico nursing homes listed on Nursing Home Compare (www.medicare.gov) from that Web site and from other sources. The data examined covered a time period from November 2007 through October 2008. Statewide ethnicity population estimates were obtained from the New Mexico Department of Health Bureau of Vital Records and Health Statistics.

To obtain a copy of the full report, contact NMMRA’s patient safety team at 1-800-663-6351 or (505) 998-9898.

As part of the National Patient Safety Initiative (NPSI), NMMRA partners with New Mexico's nursing homes to improve the publicly reported quality measures posted on Nursing Home Compare, including measures related to reducing the number of residents who are physically restrained and have pressure ulcers. NPSI projects are part of NMMRA’s New Mexico QIO contract with the Centers for Medicare & Medicaid Services (CMS).

Additional information about physical restraints, pressure ulcers and NMMRA’s work with New Mexico nursing homes is available on its Web site at www.nmmra.org/providers/nursinghomes_restraints.php and www.nmmra.org/providers/nursinghomes_ulcers.php. Information for nursing home residents and their families can be found at www.nmmra.org/resources/?group=121,