Nursing Home Quality Improvement

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Older adults in nursing homes experience a variety of geriatric syndromes which negatively impact the quality of their life. Pressure ulcers, infections, physical restraints, inappropriate antipsychotic  medications, major falls, loss of mobility and functional decline, incontinence, pain, and avoidable hospital readmissions are examples. Many of these are considered healthcare acquired conditions and can be avoided when interdisciplinary teams problem solve in real time using standards of practice for care. Best practice guidelines for geriatric care are widely available in the literature and through professional organizations. Federal and state regulatory agencies as well as consumers expect that all long-term care staff will be trained in providing the most up-to-date geriatric care. This section provides standardized tools, links to other professional websites that provide evidence-based guidelines, and a variety of resources to support you in delivering quality care.

The ACE Best Practices, a summary of recommendations and lessons learned from nursing homes participating in the last ACE series, provides excellent information on leadership presence, staff stability, consistent assignment, huddles, antipsychotic medications, hospital readmissions, and falls/mobility/alarms.

The Nursing Home Quality Care Collaborative Change Package is intended for nursing homes participating in the National Nursing Home Quality Care Collaborative (NNHQCC) to improve care for the millions of nursing home residents across the country. This change package focuses on the successful practices of high-performing nursing homes including two South Carolina facilities, NHC Healthcare – Anderson and NHC Healthcare – Parklane.

Dementia Care and Antipsychotic Medication Reduction

New national goals for continued reduction in inappropriate antipsychotic medication use have been set at an additional 15% by 2018. Making new reductions and sustaining current levels require expert dementia care skills on the part of all staff. Multiple resources are available for staff training as well as methods for safe medication reduction.

The Advancing Excellence website offers a special section that includes national best practices and resources in conjunction with the National Partnership to Improve Dementia Care in Nursing Homes. It is extensive and a valuable resource for nursing home staff.

https://www.nhqualitycampaign.org/dementiaCare.aspx

Getting To Know Your Residents: The Eden Alternative – Optimizing Medication Systems at Brookshire House
This short video illustrates how one nursing facility decreased their use of antipsychotic medications from over 70% to 6% using person-centered care that included daily exercise, music therapy, gardening opportunities, spa times, and other non-pharmacologic strategies.

https://youtu.be/xRpbpX45zcw

Tools and Resources

CMS Hand in Hand Toolkit

Every nursing home in the United States has received the CMS Hand in Hand Toolkit. Additional copies can be accessed online at http://cms-handinhandtoolkit.info/.  While this toolkit is extremely large and can be overwhelming, it contains much valuable information developed by experts in the field. Slides, videos, handouts, and exercises are all included in this train-the-trainer manual. To assist you in using the toolkit, The Carolinas Center for Medical Excellence has developed a 5-page set of instructions entitled, How to Use the CMS Hand in Hand Training for Dementia Care, that outlines the toolkit and guides you in its use.

University of Iowa Geriatric Education Center
This extensive website developed by the Iowa School of Nursing offers resources designed to help clinicians, providers, and consumers better understand how to manage behavioral symptoms and psychosis in persons with dementia using evidence-based approaches.

AMDA
The Society for Post-Acute and Long-Term Care Medicine (AMDA) website includes clinical tools, a sample medical director letter, and webinars for improving dementia care and reducing antipsychotic medications for physicians and other professionals. This is a helpful resource for increasing physician involvement.

Advancing Excellence Medications Goal
The Advancing Excellence (AE) in America’s Nursing Homes website includes medications as one of nine selected goals. Experts have developed a Medication Tracking Tool and a variety of resources related to dementia care and antipsychotic medication reduction.

National Partnership to Improve Dementia Care
The partnership of CMS with national and state agencies, nursing homes, other providers, advocacy groups, and caregivers to improve dementia care maintains a website with a variety of resources including videos and training resources as well as national information and goal setting for long-term care providers.

Alzheimer’s Association
As the leading voluntary health organization in Alzheimer’s care, support, and research, this website offers an extensive collection of dementia care practice recommendations and materials. This organization offers training for staff with a series of certification programs.

Antipsychotic Alternatives
This tool includes suggestions for reducing antipsychotic drug use and includes general principles of care as well as strategies when a resident exhibits resistance to care, disruptive behavior, and mood changes such as depression.

Antipsychotic Reduction; Resident Prioritization Tool
This two-part tool guides you through an evaluation of each resident who is on antipsychotic medications.  Following a best practice approach, the assessment identifies MDS diagnoses, recommended management of these medications, and steps to prioritize residents who are candidates for antipsychotic dose reduction.

Antipsychotic Medication Reference Tool
This tool includes indications, off label uses, side effects, and adverse effects of antipsychotic medications in an easy-to-read chart.

Promoting Positive Behavioral Health: A Non-Pharmacologic Toolkit for Senior Living Communities
This toolkit was prepared for the Commonwealth Fund in collaboration with the Hartford Foundation. It includes a review of non-pharmacologic approaches for treating behavioral symptoms of residents with dementia.

Family Brochure – How To Help Your Loved One: Improving Dementia Care by Reducing Unnecessary Antipsychotic Drugs
This is a two-page brochure for families about antipsychotic medications and appropriate use.

Al Powers, MD Blog

Al Power is a geriatrician, author, musician, and an international educator on transformational models of care for older adults, particularly those living with changing cognitive abilities. Follow his blog.

Falls and Mobility

One in two residents fall every year and of those who fall, 30-40% will fall two or more times. Falls are frequent and can result in serious fall related injuries. Falls management continues to evolve from a culture of immobility using restraints and alarms to one of increased mobility using exercises to strengthen muscles, improve balance, and build endurance in order to reduce the risk of injury. This shift is important because it means that quality of life for residents through enhanced function and mobility is the focus instead of a culture of excess safety for the convenience of staff and families.

Tools and Resources

The Falls Management Program
This comprehensive manual developed by the Vanderbilt and Emory Schools of Medicine provides a comprehensive approach for falls management in the nursing home.  It includes environmental interventions as well as protocols for nursing and therapy staff.

Department of Veterans Affairs Falls Toolkit
This toolkit from the VA National Center for Patient Safety contains best practices as well as important recommendations  on the use of hip protectors, bed height, and other equipment typically used in falls management.

Empira’s 10 Post Fall Questions
These 10 questions are used to gather information about the resident and identify relevant risk factors from staff and the surrounding environment immediately after a fall. Ideally, the questions are used during an immediate post fall huddle by unit staff for the process of root cause analysis.

Rethinking the Use of Position Change Alarms
This article by Joanne Rader, Barbara Frank, and Cathie Brady presents the negative consequences of alarm use and a good case for their reduction.

Wheelchair Seating Assessment Videos for Frontline and Therapy Staff
These videos produced by Debbie Jones, PT and JoAnne Rader, RN, MN, FAAN present several case examples of individualizing wheelchair seating designed to maximize resident function and improve quality of life.

Wheelchair Seating Assessment - Part 1
Wheelchair Seating Assessment - Part 2
Wheelchair Seating Assessment - Part 3

Business Case for Individualizing Wheelchairs
This two page document builds a strong business case for the purchase of equipment to ensure that each resident’s wheelchair is individualized correctly to maximize functional status.

IPRO Falls Data Tracking Resources
Over the past several years staff at IPRO, the Quality Improvement Organization for New York, have  developed and continuously improved an easy-to-use excel falls tracking form to monitor monthly falls. In addition, this tool includes the ability to produce graphs illustrating key variables in the Falls Statistical Trending Form.

Advancing Excellence Mobility Goal
The Advancing Excellence (AE) in America’s Nursing Homes website includes mobility as one of nine selected goals. Experts have developed a Mobility Tracking Tool and provide a wide variety of functional assessment tools, exercise programs, and materials to improve mobility in frail nursing home residents.

A Blueprint for a Falls Prevention Program
This is a slide presentation given by Sue Ann Guildermann, RN, BA, MA who reports the results of falls research in the Empira group of nursing homes including specific recommendations to reduce fall risk.

Effective Fall Prevention Strategies without Physical Restraints or Personal Alarms
This is a slide presentation by Sue Ann Guildermann, RN, BA, MA who reports the results of work in the Empira group of nursing homes to enhance mobility while reducing fall risk.

Falls Team Meeting Template and Example

Make Tracking Your Readmissions Easier
Introduced at the recent ACE learning sessions, this CCME Readmission Tracker is user-friendly and a much simpler method for tracking hospital readmissions. This Excel spreadsheet provides for easy data collection and automatically creates graphs to help you identify challenges and track your progress. Please note that the tool provides a referral for user technical support, if needed.

Hospital Readmissions

Tools and Resources

Nursing home residents frequently return to the hospital for acute changes in condition that were not identified early and managed unsuccessfully in the nursing home. The most widely used model for improving the early recognition and communication of acute changes in residents and thereby reducing avoidable hospital readmissions in long-term care is INTERACT, a comprehensive quality improvement program developed by Joseph Ouslander, MD.  A comprehensive set of  communication tools, decision support tools, and data tracking and analysis tools are located on the INTERACT website.

Advancing Excellence Hospitalizations Goal
The Advancing Excellence (AE) in America’s Nursing Homes website includes hospitalizations as one of nine elected goals. Experts have developed a hospital transfer tracking tool and a variety of resources related to reducing avoidable hospitalizations.

Make Tracking Your Readmissions Easier
Introduced at the recent ACE learning sessions, this CCME Readmission Tracker is user-friendly and a much simpler method for tracking hospital readmissions. This Excel spreadsheet provides for easy data collection and automatically creates graphs to help you identify challenges and track your progress. Please note that the tool provides a referral for user technical support, if needed.

CCME Readmission Tracker here

B & F Hospitalizations Worksheet
This is a simple spreadsheet to track monthly hospital transfers that can be used to conduct root cause analysis.

Infections

Tools and Resources

Infections are a common healthcare-acquired condition in nursing homes. The most common endemic infections are respiratory, urinary, skin and soft tissue, and gastrointestinal infections. On July 16, 2015, the Centers for Medicare & Medicaid Services (CMS) proposed a rule in the Federal Register entitled Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities. This rule required facilities to have a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases.

This section includes resources and tools for Clostridium difficile infections (CDI) and urinary tract infections, as well as organizational infection control and antibiotic stewardship practices. For resources on sepsis, please visit http://atlanticquality.org/initiatives/sepsis-initiative/.

New ACE Clostridium difficile Infection (CDI) Collaborative
CCME is beginning a new ACE CDI Collaborative and will enroll 28 South Carolina nursing homes (2016-2018). Participating in this collaborative will help your staff network with and learn from other experts in the state and the country who are working together at a national level to establish a culture of resident safety through effective and sustainable infection control and prevention systems.

The ACE CDI Collaborative aims to:

  1. Drive CDC National Healthcare Safety Network (NHSN) Long-Term Care enrollment and consistent data reporting
  2. Implement evidence-based strategies through learning focused on CDI management, antibiotic stewardship principles and practices, and the AHRQ TeamSTEPPS Long-Term Care Communications Module for uniform communication within and across nursing homes
  3. Identify a QIO-derived national baseline for CDI rates in nursing homes.

For more information about joining the collaborative please contact scace@thecarolinascenter.org.

For more information about NHSN and how to enroll, please visit the CDC NHSN website.

General Infection Control in Long-Term Care

TOOLS AND RESOURCES

The Agency of Healthcare Research and Quality (AHRQ) provides Pocket Cards for you and your staff to have on hand for 12 Common Nursing Home Situations in Which Antibiotics Are Generally Not Indicated and Infection Control Guidelines for MRSA, C. difficile, and VRE.

The Advancing Excellence website provides multiple resources and tools for infection control, antibiotic stewardship, and CDI prevention and management. It includes assessment checklists that will assist you in determining areas for improvement.

The Centers for Disease Control and Prevention (CDC) provides a wide range of resources on healthcare-associated infections (HAIs). It includes clinical staff information, resident information, prevention tools, and health department resources.  Also included are materials from the Department of Health and Human Services Steering Committee for the Prevention of Healthcare-Associated Infections.  Additional CDC resources are listed below by specific topic area.

APIC is the leading professional organization for Infection Preventionists (IPs). APIC Palmetto is the South Carolina Chapter.

Members of the Society for Healthcare Epidemiology of America (SHEA) Long-Term Care Special Interest Group (LTCSIG) updated surveillance definitions of infections for long-term care facilities which are provided in the article, Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria. The process of updating the McGeer Criteria included an evidence-based structured review of the literature in addition to consensus opinions from infectious diseases physicians, epidemiologists, infection preventionists, geriatricians, and public health officials.

This chart provides current information on HAIs in South Carolina Acute Care Hospitals and is provided by the CDC. It is a one-page outline that is useful for benchmarking with national and state rates.  

CDC provides a toolkit to assist in the assessment of infection control programs and practices in nursing homes. This document is entitled Infection Control Assessment Tool for Long-Term Care Facilities.

Chapter 8 - Long-Term Care Facilities of the National Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (April 2013) provides a guide to identify and prioritize efforts for the prevention of HAIs in nursing homes.

This position paper, SHEA/APIC Guideline:  Infection Prevention and Control in the Long-Term Care Facility, provides basic infection control recommendations that can be applied to reduce HAIs in long-term care facilities. The efficacy of these measures in long-term care, in most cases, is not proven by prospective controlled studies but is based on infection control logic, adaptation of hospital experience, long-term care facility surveys, CDC authored and other guidelines containing specific recommendations for long-term care, and field experience.

The risk for breaks in infection control can be high for everyone involved in the transfer of an infected patient.  CDC developed a two-page tool, Inter-Facility Infection Control Transfer From, compiling infection related information that is valuable not only to the transferring facility but also to the transporters.

Clostridium difficile Infection (CDI)
Of particular concern for nursing homes is the high prevalence of CDI and the associated morbidity and mortality of those 65 years and older. Studies have shown that long-term care residents are at higher risk of acquiring Clostridium difficile from referring hospitals and transitions of care. Hence, it is reasonable to assume that a CDI manifestation in a long-term care facility is correlated with the CDI in hospitals where most residents receive care. According to a CDC study, more than 100,000 Clostridium difficile infections develop among residents of U.S. nursing homes each year; one out of every three infections occurs in residents 65 years or older; and more than 80% of deaths associated with CDI occur among Americans aged 65 and older.  As such, the significance of addressing CDI reporting and reduction has come to the forefront of the nursing home industry.

TOOLS AND RESOURCES
The Centers for Disease Control and Prevention provides a wide range of resources on CDI.

The Agency for Healthcare Research and Quality (AHRQ) provides a comprehensive update to an earlier publication which is titled, Early Diagnosis, Prevention, and Treatment of Clostridium difficile: Update.

IPRO, the New York state Quality Improvement Organization (QIO), provides a one-page guide for CDI management, Bundle Strategies for the Management of Clostridium Difficile Infection.

CDI Toolkit:  A Healthcare Provider’s Guide to Preventing CDI. This 27-page toolkit provides specific information related to hand hygiene and other infection control measures related to CDI prevention as well as organizational considerations such as program leadership and communication.
This article by the Society for Healthcare Epidemiology in America (SHEA) highlights practical recommendations to assist acute care hospitals in implementing a CDI prevention program. The majority of these recommendations are applicable to nursing homes.  SHEA’s mission is to prevent and control healthcare-associated infections through the development of best practices in healthcare epidemiology worldwide.  

Algorithm for Stool Collection Tool is a one-page flowchart for deciding when to send a stool specimen to the lab for the identification of possible pathogens. This decision guide was developed by IPRO, the New York state Quality Improvement Organization, and is based on information from the Society for Healthcare Epidemiology of America.

In response to those affected by CDI in the community and in health care settings, the C Diff Foundation formed and provides information, advocacy, and support. The site includes education, podcasts, homecare instructions, as well as events and programs.

Antibiotic Stewardship
Fifty to 70% of nursing home residents take one or more courses of antibiotics over the progress of a year. It is estimated that 25 to 75% of antimicrobial use in nursing homes may be inappropriate. As a result, many of the adverse drug events, heightened risk of CDI, and antibiotic resistance associated with the use of antibiotics in long-term care may be avoided when antibiotic stewardship principles are applied.

TOOLS AND RESOURCES
The Agency of Healthcare Research and Quality (AHRQ) has a website which focuses on Antimicrobial Stewardship in the Nursing Home. It provides additional links to use of its Antimicrobial Stewardship Guide, Toolkits, Guidance on When to Treat a Potential Infection with Antibiotics , and a Toolkit on How to Educate and Engage Residents and Family Members.

The Centers for Disease Control and Prevention (CDC) provides a number of resources and tools. This publication provides the core elements of a long-term care antibiotic stewardship program. This tool is an easy checklist of antibiotic stewardship program components.

Appendix A:  Policy and Practice Actions to Improve Antibiotic Use published by the CDC contains detailed explanations of policy and practice actions which can be taken by nursing homes as part of their antibiotic stewardship activities.

Appendix B:  Measures of Antibiotic Prescribing, Use, and Outcomes published by the CDC contains detailed explanations of antibiotic use process and outcome measures which can be tracked by nursing homes to monitor the impact of their antibiotic stewardship activities.

The Antibiotic Stewardship Change Package is a one-page outline of drivers and key concepts from the CDC’s Get Smart Campaign.

This presentation by Dr. Nimalie Stone from the CDC describes national priority areas for healthcare-associated infection prevention in nursing homes and highlights the role of antibiotic stewardship in reducing these infections and antibiotic resistance. This is an excellent overview which describes examples of current national and state programs.

This article, Ten Clinical Situations in Long-Term Care for which Antibiotics are Often Prescribed but Rarely Necessary, provides an overview of when and when not to prescribe antibiotics to nursing home residents.

This collaborative review from the Infectious Diseases Society of America provides guidelines for developing institutional programs to enhance antimicrobial stewardship including the appropriate selection, dosing, route, and duration of antimicrobial therapy.  Although it focuses on the acute care setting, many of the guidelines are applicable to long-term care.

Antibiotic Stewardship:  Why We Must and How We Can is a presentation by Dr. Arjun Srinivasan which outlines the case for antibiotic stewardship and key principles for developing a program.

Urinary Tract Infections (UTI)

TOOLS AND RESOURCES
This article, Urinary Tract Infection in Older Adults, provides an overview that includes key aspects of diagnosis and treatment. It also includes a diagnostic algorithm for urinary tract infection in long-term care facilities in those residents without an indwelling catheter.

Take an online course from the Borun Center at UCLA’s Division of Geriatrics on reducing incontinence and developing a prompted voiding program for older adults. 

This article, Urinary Tract Infections in Older Adults Residing in Long-Term Care Facilities, provides a good overview that includes UTI epidemiology, symptoms, treatment, and management.

Over diagnosis and over prescription of antibiotic therapy to treat UTIs in long-term care settings is a problem that has recently come under the scrutiny of clinicians, medical directors, policymakers, and regulators. The growing number of nursing homes recently cited with inappropriate antibiotic use highlights a need to revisit the way in which UTIs are identified and managed in these settings. This article, Improving the Management of Urinary Tract Infections in Nursing Homes: It’s Time to Stop the Tail from Wagging the Dog, addresses some of the reasons why antibiotic therapy is often overprescribed and proposes recommendations for a new stepwise approach to diagnosing UTIs in residents of long-term care facilities, including determining when antibiotic therapy is the appropriate course of action.

Distinguishing UTI from bacteriuria is challenging.  In Diagnosis and Management of Urinary Tract Infection in Older Adults, the authors identify the prominent organisms seen in UTIs and present diagnostic and treatment algorithms.

The Virginia Department of Health has developed a comprehensive list of resources and toolkit for addressing UTIs in long-term care.

Catheter-Associated Urinary Tract Infections (CAUTI)

TOOLS AND RESOURCES

The Centers for Disease Control and Prevention provides a wide variety of resources and tools for preventing catheter-associated urinary tract infections which include an updated guideline of evidence-based practice. This is an excellent, comprehensive resource.

AHRQ Evidence-Based Practice Guidelines for Urinary Tract Infections includes background, local microbiology data, and suggested empiric regimens.

The new edition of the Guide to Preventing Catheter-Associated Urinary Tract Infections (CAUTI) by APIC expands on the 2008 Elimination Guide and contains updated content on the epidemiology and causes of CAUTI, as well as detailed information on surveillance and reporting. Developed by a team of infection prevention experts, the guide also features new content that addresses patient safety, the Comprehensive Unit-based Safety Program (CUSP), and other behavioral models for CAUTI prevention. Additionally, this guide includes new information on CAUTI prevention in special populations, including pediatric, spinal cord injury, long-term care, and intensive care unit patients.

The Institute for Healthcare Improvement (IHI) provides a How-to Guide:  Prevent Catheter-Associated Urinary Tract Infection. This guide describes key evidence-based care components for preventing catheter-associated urinary tract infections, describes how to implement these interventions, and recommends measures to gauge improvement. You must register to access this document but registration is free.

This chapter, Reducing Unnecessary Urinary Catheter Use and Other Strategies To Prevent Catheter-Associated Urinary Tract Infections: Brief Update Review, provides an overview of best practice for the use of urinary catheters and the prevention of infection.

Pain

Numerous acute and chronic conditions common in nursing home residents are associated with pain. Yet proper assessment and treatment of pain in frail older adults is complex and challenging due to the high prevalence of comorbidities, cognitive and sensory impairment, depression, and difficulty communicating in this population. Untreated pain comes at a high cost and is associated with depression, decreased socialization, sleep disturbance, impaired ambulation, and increased healthcare expenditures. Consistent staff awareness and responsiveness using evidence-based interventions in conjunction with resident and family education are vital for proper pain management in the nursing home.

TOOLS AND RESOURCES
National Website for Pain in Older Adults
Geriatric Pain is an excellent website dedicated to helping clinicians assess and manage pain in older adults. It provides a wide range of free evidence-based tools and best practices for clinicians working with older adults.

QAPI Tool Used by PIP Team Working to Improve the Quality Measure for Pain
The Village of Summerville adapted a QAPI Tool for use when improving an outcome or process. This copy is blank and this copy demonstrates the work of the performance Improvement Team (PIP) for Pain.

American Pain Society
The American Pain Society is a multidisciplinary community that brings together a diverse group of scientists, clinicians, and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.

Physical Restraints

The use of physical restraints in U.S. nursing homes has dramatically reduced over the last two decades. Currently, the national rate of physical restraint use is 0.9%. This means that fewer than 1% of all residents in nursing homes in the country are physical restrained, down from 30-40% prior to the major nursing home reforms of the early 1990’s. High performing nursing homes do not use physical restraints and have not for many years.

However, the rate of physical restraint use in South Carolina is twice the national average and continues to be over 2%. In order to come into line with the national rate or better and improve the dignity and lives of frail older adults living in our nursing homes, please use the following resources to implement best practice guidelines for eliminating physical restraints.

Tools and Resources

CMS RAI MDS 3.0 Manual Section P: Restraints
Coding properly depends upon a thorough understanding of the definitions and processes outlined in the RAI manual. This section of the manual will provide your team with an understanding of terms, definitions, use of restraints.

CMS Memo Clarification of Terms
This memo clarifies terms and definitions in the federal guidelines for physical restraint use.

Eliminating Physical Restraints in your Nursing Home
This tool outlines organizational support, family engagement, teamwork, implementation of a no restraint use policy, and evaluation for the elimination of physical restraints.

Restraints: Staff Attitudinal Survey
This tool assesses staff opinions and helps to clarify myths and misconceptions of staff when used during staff training and education.  

Restraint Alternatives
This tool offers alternatives to physical restraint use including general principles, behavioral/medical condition therapeutic interventions, environmental and equipment interventions, and activity interventions.

Rounding with the 4 P’s
This is a process for systematic rounding which can be use proactively to identify resident needs and respond appropriately.

Sunshine Room Guidelines
This tool outlines the use of an intensive care room to provide a safe monitored environment for a small group of residents who need increased supervision and who will benefit from individualized attention from staff.

Device Decision Guide
This tool outlines the decision making process for determining if a device is a physical restraint, an enabler, or both.

Activity Boxes
This tool lists contents for several different types of activity boxes used to engage residents.

Restraints and Falls: Legal Perspective
This fact sheet outlines the legal issues related to falls and physical restraint use commonly seen in long-term care.

Safety Without Restraints: Fall and Restraint Facts for Residents and Families
This brochure outlines the negative consequences of restraint use and provides convincing evidence for their elimination in the nursing home setting.

Pressure Ulcers

Pressure ulcers are a serious and common geriatric syndrome with more than one million patients in acute and long-term care affected annually. Pressure ulcers often impair the older adult’s ability to perform activities of daily livening and are associated with increased morbidity and mortality. Their treatment in nursing homes is expensive and the personal burden of pain, depression, stress from extended treatment protocols, altered self-image is significant. Clinical practice, expert opinions, and the published literature indicate that most, but not all, pressure ulcers can be prevented.

Tools and Resources

National Pressure Ulcer Advisory Panel
The NPUAP serves as the authoritarian voice for improving patient outcomes in the prevention and treatment of pressure ulcers through public policy, research and education. It offers resources and training tools for staff training as well as the latest best practice for pressure ulcers.

The Advancing Excellence (AE) in America’s Nursing Homes website includes pressure ulcers as one of nine elected goals. Experts have developed a pressure ulcer transfer tracking tool and a variety of resources related to preventing and healing pressure ulcers.

It Takes a Team to Reduce Pressure Ulcers
This one page fact sheet summarizes the role of leadership, nurse manager, wound nurse, and staff nurse in the prevention and treatment of pressure ulcers.

AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention
The Agency for Healthcare Research and Quality (AHRQ) created On-Time Pressure Ulcer Prevention to help nursing homes with electronic medical records reduce the occurrence of in-house pressure ulcers.

IPRO Pressure Ulcer Data Tracking Resources
Over the past several years staff at IPRO, the Quality Improvement Organization for New York, have  developed and continuously improved an easy-to-use excel tracking form to monitor monthly pressure ulcers. In addition, this tool includes the ability to produce graphs illustrating key variables in the Pressure Ulcer Statistical Trending Form.

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Contact Us

Nancy (Libby) Lawson, M.Ed., RN
Quality Specialist
Tel: 803-212-7500 ext. 5619
nlawson@thecarolinascenter.org
scace@thecarolinascenter.org