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 10 Signs Your QA Efforts for Pressure Ulcers May Not Be Working

From Ohio KePro, March, 2007 

1. Caregivers do not notice (or document) developing stage one pressure ulcers. Early detection (noticing red areas or other signs of skin breakdown, i.e., changes in skin temperature, bogginess, etc.) of Stage 1 ulcers is vital in preventing the harder to treat higher-stage ulcers. All residents should receive a weekly skin inspection of all parts of the body and any skin abnormalities should be documented. If developing ulcers aren't documented until they become a Stage 2 or higher, they will be much more difficult to treat and heal, and will likely be accompanied by more pain and other negative side effects.  

2. Your definition of "high risk" does not include all the risk factors. The MDS 3.0 (and your QI/QM reports) considers a resident at high risk for pressure ulcer development if he/she meets any one of the following criteria: comatose, bed or chair bound, limited transfer capability, or has malnutrition. Clinical guidelines suggest that there are many other risk factors for pressure ulcer development, so you should use a comprehensive risk assessment tool on every resident at admission, quarterly, and with any significant change in condition. 

3. The pressure ulcer team doesn't complete pressure ulcer risk assessments frequently enough. Remember that the key to pressure ulcer prevention is to identify a resident's risk factors, and put into place some interventions to help lessen the effects of those risk factors. Be sure you assess risk on a routine basis, including newly admitted residents. 

4. The pressure ulcer team doesn't differentiate between pressure-reducing and pressure-relieving materials. These products provide varying levels of pressure relief, and should be used on residents who require that level of relief or reduction. Properly assess residents' needs and provide the appropriate surface to help prevent pressure ulcer development. 

5. Staff nurses over-rely on the designated wound-care nurse. Your floor staff should take an active role in pressure ulcer prevention and treatment, rather than allowing assessments and orders to fall on the designated treatment nurse. Encourage all caregivers to take "ownership" of the prevention and treatment process. 

6. You simply accept the number of wounds in your building. As long as wounds aren't developing "in-house," often there is the temptation to overlook the quality measure reports. With appropriate treatment, however, the number of existing wounds should decline, not remain at a consistent high level. Also, remember that consumers now have access to information via the Internet, so you should be prepared to discuss your QM scores with potential residents and families.  

7. Dietary doesn't have a current list of residents with pressure ulcers. Nutritional consults and interventions are vital to wound healing. Be sure your dietitian stays up-to-date on the skin status of each of the residents. 

8. Residents are not assessed for wounds prior to admission. If you don't know that a resident who is being admitted has an existing pressure ulcer (or is at high risk for pressure ulcers), you cannot put immediate interventions in place upon admission. Remember that pressure ulcers can develop or worsen in two hours or less, so you do not want to delay interventions.  

9. Wound-care nurse does not follow current clinical guidelines. Your designated wound care nurse should be a clinical expert when it comes to appropriate treatments for wounds. As  recommendations and therapies change, he or she should stay apprised of any new clinical guidelines and treatment options.  

10. Care plans are not being followed. Periodically assess your high-risk residents to be sure their care plans are being followed. For example, is staff compliant with turning schedules, positioning devices, incontinence care, moisture barrier creams and nutritional supplements and snacks?

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