Nursing Homes - Pressure
This web page is intended to provide information to assist nursing home staff
to prevent and reduce the number of pressure ulcers in nursing homes.
Data from the 2004 National Nursing Home Survey was published in the
February 2009 National Center for Health Statistics Data Brief. This data
brief presents the most recent national estimates of pressure ulcer
prevalence, resident characteristics associated with pressure ulcers, and
the use of wound care services in U.S. nursing homes. Key findings
- In 2004, more (11%) than 1 in 10 nursing home residents had pressure
ulcers. Stage 2 pressure ulcers were the most common.
- Residents aged 64 years and under were more likely than older
residents to have pressure ulcers.
- Residents of nursing homes with a length of stay for a year or less
were more likely to have pressure ulcers than those with longer
- One in five nursing home residents with a recent weight loss had
- Thirty-five percent of nursing home residents with stage 2 or higher
(more severe) pressure ulcers received special wound care services in
Pressure ulcers, also known as bed sores, pressure sores, or decubitus
ulcers, are wounds caused by unrelieved pressure on the skin. They usually
develop over bony prominences, such as the elbow, heel, hip, shoulder, and
back. Pressure ulcers are serious medical conditions and one of the
important measures of the quality of clinical care in nursing homes.
Pressure ulcers are preventable and numerous guidelines exist for the
prevention and treatment of pressure ulcers.
Wisconsin Clinical Resource Center
The Wisconsin Clinical Resource Center (WCRC) project is jointly
sponsored by the Department of Health Services, LeadingAge Wisconsin and
the Wisconsin Health Care Association (WHCA/WiCAL), through funding from
the Wisconsin Department of Health Services. Development support is
provided by staff from the Center for Health Systems Research &
Analysis (CHSRA), University of Wisconsin-Madison. The WCRC website was
designed as a user-friendly resource to provide key information to staff
working in Wisconsin nursing homes about selected care areas and training
REGISTER now for Individual
Log-ins!! Current log-in procedures are changing to allow individual
nursing home staff to access the website. Previous facility passwords will
no longer be available after October 15, so spread the word about these
changes! Here is all the information you need to know to ensure that you
and your nursing home continue to have access to the WCRC resources:
STEP 1: Go to the WCRC Website Address: https://wcrc.chsra.wisc.edu (exit DHS)
STEP 2: Click the link that says “Register”.
STEP 3: Follow the prompts to sign up for an individual logon.
For more information - contact your nursing home association, WCRC
email: firstname.lastname@example.org, WCRC
Wisconsin Pressure Ulcer Coalition
The Wisconsin Pressure Ulcer Coalition (WPUC) was formed in December
2007 and is comprised of several Wisconsin stakeholder groups including
the Division of Quality Assurance, Wisconsin Homes and Services for the
Aging, Wisconsin Health Care Association, Wisconsin Hospital Association,
Rural Wisconsin Health Cooperative Health Initiative, MetaStar, and
representatives from nursing homes, home health, hospice and assisted
living. The primary mission of the WPUC is to reduce the incidence and
prevalence of pressure ulcers using proven strategies.
In the fall of 2008, the WPUC invited hospitals, nursing homes,
assisted living, home health, and hospice providers to participate in a
one year collaborative improvement project that emphasizes the use of
evidence based guidelines to prevent pressure ulcers. The project began in
early December with the first training session held on January 15th, 2009
in Wisconsin Dells. The project is modeled after the very successful New
Jersey Pressure Ulcer Collaborative that significantly reduced pressure
ulcers across the continuum of care.
Participating organizations were expected to develop a team and be
actively involved in the improvement methodologies. The project consists
of two in-person learning sessions, teleconferences, monthly data
submission and ad hoc support. Individualized reports are provided that
highlight improvements made in reducing pressure ulcers within each
organization. The project emphasizes the importance of working across the
care continuum by partnering nursing homes, hospitals and providers from
other care settings with each other so that communication and problem
The WPUC is currently in the process of recruiting nursing homes for
year two. For more information about the WPUC, contact Jody Rothe RN, WCC at
(608) 441-8271 or via email at email@example.com
CMS GPRA Goal
The Centers for Medicare & Medicaid Services' (CMS) two Government
Performance Results Act (GPRA) goals for nursing homes include reducing
the number of pressure ulcers in nursing homes. These goals were first
articulated in CMS
Survey & Certification (S&C) Letter number 05-01 (exit
Guidance on Working with Quality Improvement Organizations.
In July 2006, CMS Region 5 provided the DQA with regional GPRA goals
for pressure ulcers and restraints. The CMS Regional GPRA goal for
pressure ulcers was set at 7.4%.
Every quarter, the DQA monitors the progress of Wisconsin nursing homes
in achieving the GPRA goals. Wisconsin's average percentage of pressure
ulcers is 7.0% based on first quarter 2009 data. You may view
the progress of pressure ulcer reduction in Wisconsin nursing homes at the following links:
Percent of Residents with Pressure Ulcers
- 1st Quarter 2009 (PDF, 190 KB)
Percent of Residents with Pressure Ulcers
- 4th Quarter 2008 (PDF, 190 KB)
One of the primary ways that CMS has promoted the reduction in the
number of pressure ulcers is through the annual survey process.
State and CMS surveyors who conduct annual inspections of nursing homes
will focus on these areas during every annual survey.
Therefore, prior to each nursing home's annual survey, state surveyors review each
nursing home's Quality Measure/Quality Indicator (QM/QI) Reports to
determine if the nursing home's "observed percent" of pressure
ulcers is 7.4% or above. The survey team must select this area for
review for any nursing home whose "observed percent" is at or
above this threshold.
- Nursing home staff may use CASPER via their access to the State MDS
System to generate and retrieve QM/QI reports for their
- The Medicare
Nursing Home Compare website (exit DHS) uses a Five Star Quality Rating
System to compare nursing homes. The Quality Measure domain
includes the percent of high-risk long-stay residents who have
pressure sores and the percent of short-say residents with pressure
sores as two of the ten QMs that are used in the rating methodology.
- Nursing Home QI/QM User Manual is available on the Downloads area of
Nursing Home Quality Initiatives website (exit
The DQA strongly recommends that all nursing homes routinely monitor
their Quality Measure/Quality Indicator Reports with their medical
director and quality assurance committee to determine if their
"observed percent" is at or above the thresholds for pressure
ulcers. As the majority of serious deficiencies issued in 2008 and
2009 for pressure ulcers were related to breakdowns in the care process
related to lack of timely assessment, care planning, consistent
implementation of the care plan and reevaluation of the care plan.
The medical director and quality assurance committee should also review on
a monthly basis the number of pressure ulcers that are present on
admission versus facility acquired pressure ulcers. A root-cause
analysis should be completed for any resident who developed a facility
acquired pressure ulcer.
Regulations and Violations
Federal Regulation - §483.25(c)
Based on the comprehensive Assessment of a resident, the facility must
1) A resident who enters the facility without pressure sores does not
develop pressure sores unless the individual’s clinical condition
demonstrates that they were unavoidable; and
2) A resident having pressure sores receives necessary treatment and
services to promote healing, prevent infection and prevent new sores from
State Code - 132.60(1)(b) - Decubiti Prevention.
Nursing personnel shall employ appropriate nursing management techniques
to promote the maintenance of skin integrity and to prevent development of
decubiti (bedsores). These techniques may include periodic position
change, massage therapy and regular monitoring of skin integrity.
132. 60(1)(b) Nursing Home
Violations by Class and Year (PDF, 15 KB)
Civil Money Penalties and Forfeitures
Nursing homes may be assessed Civil Money Penalties (CMPs) for federal
citations and/or Forfeitures for state citations. Listed below are
statistics related to CMPs and Forfeitures for citations issued related to
|CY 2009 (as of 9/1/09)
RN, BSN, Nurse Consultant
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Last Updated: November 20, 2013