Nursing Homes

Quality Measures: Pressure Ulcers in Nursing Homes

Quality Measure Description:
The percent of residents who are reported to have one or more pressure sores on the OBRA Full or Quarterly Assessment.

Rationale for Pressure Ulcer QM:
Between 3% and 5% of residents in nursing facilities have pressure ulcers. 60% or more of residents will typically be at risk of pressure ulcer development. Pressure ulcers can have serious consequences for the elderly and are costly and time consuming to treat. However, they are one of the most common, preventable and treatable conditions among the elderly who have restricted mobility. Successful outcomes can be expected with preventative and treatement programs. Assessment goals are:

1. To ensure that a treatment plan is in place for residents with pressure ulcers; and
2. To identify residents at risk for developing a pressure ulcer who are not currently receiving some type of preventative care program.

A pressure ulcer is an injury usually caused by unrelieved pressure that damages the skin and underlying tissue. Pressure ulcers are also called decubitis ulcers, pressure sores, or bedsores and range in severity from mild (minor skin reddening) to severe (deep craters down to muscles and bone). They can occur anywhere on the body where unrelieved pressure on the skin squeezes tiny blood vessels, which supply the skin with nutrients and oxygen. When skin is starved of nutrients and oxygen for too long, the tissue dies and a pressure ulcer forms. The affected area may feel warmer than surrounding tissues. Skin reddening that disappears after pressure is removed is normal and not a pressure ulcer.

Other factors cause pressure ulcers, too. If a person slides down in the bed or chair, blood vessels can stretch or bend and cause pressure ulcers. Even slight rubbing or friction on the skin may cause minor pressure ulcers.

Nerves normally tell the body when to move to relieve pressure on the skin. Persons in bed who are unable to move may get pressure ulcers after as little as 1 to 2 hours. Persons who sit in chairs and who cannot move can get pressure ulcers in even less time because the force on the skin is greater.

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