A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear (npuap.org).

Pressure ulcers are costly, painful and are often perceived as the result of poor quality care.  The Center for Medicare and Medicaid Services has included pressure ulcer risk assessment and implementation of prevention protocols in the OASIS-C. Home health agencies that fail to identify patients at risk are missing an important step to preventing pressure ulcers that occur under the care of the agency.

Tools for Outcome Measurements

Pressure ulcer prevention begins with risk assessment.  In the  OASIS-C item M1302, The Center for Medicare and Medicaid (CMS)  asks that patients be identified with or without a formal pressure ulcer screening tool. Agencies should choose a validated pressure ulcer screening tool. The Braden Scale (Bergquis & Frantz, 2001) has been validated with home care populations, but it is not the only validated tool available. The Norton and the Waterlow Scale are also good alternatives. What is more important is accuracy and consistency in use. This can only be accomplished through staff education.

Once the risk assessment is completed, implementation of  pressure ulcer prevention measures should be based on the information obtained. The Braden Scale has a set of measures correlated to the risk identified (www.bradenscale.com). Many clinicians use the overall Braden score as a starting point for deciding risk. However, when sub-scale scores such as mobility, incontinence or shearing are triggered, it is just as important to address these with appropriate prevention measures.

Several factors impact pressure ulcer prevention in the home. Taking these factors into prevention planning will improve an agency’s ability to avoid pressure ulcers in their patients.

Accurately Assessing Pressure Ulcers