Pressure ulcers can be dangerous and painful for nursing home residents and can sometimes lead to serious medical complications and even death. As the Medicare Quality Improvement Organization (QIO) for Arkansas through July 2014*, the Arkansas Foundation for Medical Care (AFMC) worked with nursing homes to lower and eliminate occurrences of pressure ulcers. Here’s one example of how the QIO's technical assistance helped a rural 130 bed nursing home to eliminate these wounds.
In August 2012, the nursing home had only one treatment nurse – a nurse whose specific function is to provide the necessary treatment of patient diagnoses (i.e. wound care) – on staff, leaving the nurse no time to train care staff on preventive measures. Recognizing the severity of the problem, the nursing home’s corporate office hired a second treatment nurse and signed on with AFMC‘s high-risk pressure ulcer reduction program. The nursing home received assistance from AFMC to ensure it was using current evidenced-based protocols.
Among the best practices the nursing home implemented were:
- Conducting a risk assessment within 24 hours of the arrival of each new resident
- Implementing prevention measures immediately
- Ensuring each resident’s care plan is regularly updated
- Ensuring pressure ulcer prevention training is following evidence-based protocols
- Ensuring patient monitoring and treatment documentation meet clinical standards
With two treatment nurses on staff, the nursing home began to train care staff on how to prevent pressure ulcers. In addition, treatment nurses began to accompany care staff on daily rounds of all residents, a process that enables one-on-one, in-the-moment interactions with patients and staff and has made staff more aware of the importance of proper positioning of patients to help prevent pressure ulcers.
With AFMC’s help, the nursing home’s incidence of high-risk pressure ulcers dropped from 5.1 percent to zero, where it remained for six consecutive months.
*In spring of 2014, CMS determined to separate the consumer type protection activities - case review, beneficiary complaint and appeals - from the quality improvement work for the QIO program going forward. As of August 1, Arkansas is represented by two Quality Improvement Organizations. TMF Health Quality Institute has partnered with the Arkansas Foundation for Medical Care, Primaris in Missouri and the Quality Improvement Professional Research Organization, Inc. in Puerto Rico to form the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) to provide quality improvement work throughout Arkansas, Missouri, Oklahoma, Puerto Rico and Texas. Beneficiary and family centered care services are now provided by KEPRO.