\Question: What are Quality Measures, how does my long-term care facility measure up, and how can we improve?

Answer: Proper pressure injury staging on admission, that's how! As a wound nurse, DON, ADON, or administrator in a long-term care facility, you have likely heard the following terms: Quality Measures, In-House Percentage, Five Star Rating, and maybe even Nursing Home Compare. It is important to familiarize yourself with the meaning of these items and how your role impacts them. The information specific to your nursing home facility can be found on the Nursing Home Compare site. According to Medicare.gov, nursing home quality measures have four intended purposes:

• To give you information about the quality of care at nursing homes in order to help you choose a nursing home for yourself or others;
• To give you information about the care at nursing homes where you or family members already live;
• To give you information to facilitate your discussions with the nursing home staff regarding the quality of care; and
• To give data to the nursing home to help them in their quality improvement efforts.

Wound Care Quality Measures: Pressure Injury Percentages

The Wound Care Quality Measures are broken up into two categories: percentage of short-stay residents with new or worsening stage 2-4 pressure ulcers*, and the percentage of long-stay residents at high risk for pressure ulcers, with a stage 2-4 pressure ulcer not present on admission. One key to reducing the percentages lies within the accuracy of your admission assessments. When a resident enters your facility with a pressure injury, you must accurately assess the level of tissue damage to ensure you will not be required to document the pressure as worsened based on subsequent assessments. For example: common mistake I see when reviewing documentation is the incorrect admission assessment documentation of a stage 2 pressure injury. Subsequent assessments just days later are documented with all of the same measurements, but now there is slough present in the wound bed indicating this is a stage 3 pressure injury.

On paper this is determined to be a worsening pressure injury and is now the responsibility of the facility. In reality, this wound was a stage 3 pressure injury with 100% clean granulation tissue on admission. There are several ways to prevent this mistake in documentation. First, it is important to review any documentation that came with the resident indicating the stage of the pressure injury. However, it is much more important to be able to accurately identify the tissue of the wound bed. A 100% granulating wound bed (stage 3 pressure injury) is often confused with 100% exposed dermis (stage 2 pressure injury).

Knowing the difference between the different types of tissue found in pressure injuries is crucial to an accurate admission assessment. Making yourself aware of how your facility measures up regarding the Quality Measures directly related to wound care solidifies your commitment to high quality wound care. Knowing where you stand it will also act as a motivator and help your wound team set goals to achieve a 0% in-house acquired Pressure Injury Percentage.

*Note: The Centers for Medicare and Medicaid Services still currently utilizes terminology implemented prior to the April 2016 NPUAP consensus panel.

About the Author

Terri Kolenich, RN, CWCA, AAPWCA is the clinical liaison at Select Medical Specialty Hospitals. Terri has extensive experience in long term care as a Wound Care Nurse and Program Manager. She is passionate about wound care education and has over nine years experience assessing, managing, and documenting wounds. Terri is also well versed in MDS 3.0. Her knowledge coupled with her skill as a public speaker, make her an effective wound care educator.