Pressure Ulcers are a focused Quality Measure for 5 Star Ratings and Post Acute Care
CMS uses Health Inspections, Staffing Ratios, and Quality Measures to create the 5 star rating for nursing facilities. One of the Quality Measures is pressure ulcers. For short stay residents CMS looks at percent of residents with pressure ulcers that are new or worsened. Specifically, this measure captures the percentage of short-stay residents with new or worsening Stage II-IV pressure ulcers. For long stay residents CMS looks at percent of high risk residents with pressure ulcers. Specifically, this measure captures the percentage of long-stay, high-risk residents with Stage II-IV pressure ulcers. Residents at high risk for pressure ulcers are those who are impaired in bed mobility or transfer, who are comatose, or who suffer from malnutrition. These Quality Measures are reported by the nursing home through the Minimum Data Set or MDS.
Quality health care for people with Medicare is a high priority for the President, the Department of Health and Human Services (HHS), and the Centers for Medicare & Medicaid Services (CMS). On September 18, 2014, Congress passed the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act). In order to implement the IMPACT Act, the Centers for Medicare & Medicaid Services (CMS) contracted with RTI International and Abt Associates to identify, develop, and maintain post-acute care cross-setting quality measures for the IRF, LTCH, SNF, and HHA settings. A Technical Expert Panel identified three cross-setting quality measures:
1. National Quality Forum (NQF) #0678: Percentage of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay)
2. An Application of NQF #0674: Percentage of Residents Experiencing One or More Falls with Major Injury (Long Stay)
3. An Application of Percentage of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631; under NQF review)
Facilities that are looking to improve their Pressure Ulcer Quality Measure and maintain or improve their PAC results should focus on pressure ulcers in 3 ways:
- Educate all caregivers on skin care techniques that prevent pressure ulcers, on assessment for pressure ulcer risk, and institute pressure ulcer prevention programs.
- Constantly reassess patients that have worsening wounds and implement new management strategies and care protocols to improve those wounds.
- Monitor the progression of all pressure ulcers including Stage 1 pressure ulcers.
At the Skilled Wound Care program we are aware of these quality measures and our goals are to prevent worsening decline of wounds, identify wounds early, and heal wounds as rapidly as possible.