Nursing home quality and pressure ulcer prevention and management practices

Abstract

Objectives: To measure pressure ulcer quality indicator (QI) scores and to describe the self-reported skin integrity assessment, pressure ulcer risk assessment, and pressure ulcer prevention and treatment practices in long-term care facilities (LTCFs).

Design: Retrospective analysis of a large data set and comparative survey.

Setting: LTCFs in Missouri.

Participants: Three hundred sixty-two LTCFs participated in the survey. Three hundred twenty-one facilities had pressure ulcer QI scores between April 1 and September 30, 1999.

Measurements: Pressure ulcer QI scores, Pressure Ulcer Prevention & Treatment Practices Survey.

Results: The mean+/-standard deviation pressure ulcer QI score was 10.9+/-6.2%, with a risk-adjusted score of 15.7+/-8.9% for high-risk residents and 3.1+/-3.6% for low-risk residents. Minimizing head-of-bed elevation to less than 30 degrees was used by fewer than 20% of facilities. More than 40% of facilities used a risk assessment tool that was not evidence based. Fewer than 13% of facilities used the Agency for Health Care Policy and Research pressure ulcer prevention and treatment guidelines. No relationship was found between the number of prevention strategies (P=.892) or the number of treatment strategies (P=.921) and the pressure ulcer QI scores.

Conclusion: Valid and reliable pressure ulcer risk assessment tools are seriously underused. Evidence-based pressure ulcer prevention and treatment guidelines appear to be rarely implemented. This study provides a basis for developing educational and quality improvement programs and future research related to pressure ulcer prevention and treatment in LTCFs.