• American Medical Directors Association. Tool kit for implementation of the clinical practice guidelines for pressure ulcers [binder]. Columbia (MD): American Medical Directors Association (AMDA); 2004. various p.

Does not apply to this measure

This measure is used to assess the percentage of patients with pressure ulcer or pressure ulcer risk factors with documented periodic assessment for specific risk factors.

In the institutional setting, the prevalence of patients with pressure ulcers is between 2.5% and 24%, with an average of 1.6 to 2.5 wounds per patient. The incidence of pressure ulcers in nursing facilities is 0.20 to 0.56/1000 patient-days, which may increase to 14/1000 patient-days among those at high risk. The aged are most susceptible, with 70% of pressure ulcers occurring in patients over age 70. The most commonly affected sites, compromising approximately 80% of wounds, are the pelvic girdle (including ischium, sacrum, coccyx, and trochanters) and heels. A patient with a pressure ulcer has a 2 to 6 times greater mortality risk than one with intact skin.

While pressure ulcers sometimes develop in spite of the best efforts of nursing staff and other multidisciplinary team members, many of these ulcers can be healed if detected promptly and treated at an early stage. Other pressure ulcers are not preventable or may be slow to heal because of patient factors that cannot be changed.

This is one of American Medical Directors Association's (AMDA) twelve suggested quantitative process or clinical outcomes measures related to implementation of pressure ulcer clinical practice guidelines (CPGs) in a long-term care facility. These measures are based on the four components of the AMDA pressure ulcers management process: Recognition, Assessment, Treatment, and Monitoring.

Pressure ulcer; assessment for risk factors

All patients who have a pressure ulcer or pressure ulcer risk

Number who have pressure ulcer or pressure ulcer risk with documented periodic assessment for specific risk factors

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Use of this measure to improve performance

• Calabrese B. (Director of Research, Clinical Nurse Manager, AMDA Foundation. Columbia, MD). Personal communication. 2005 Oct 3.  2 p.

Current routine use

Internal quality improvement

Long-term Care Facilities

Advanced Practice Nurses
Allied Health Personnel
Dietitians
Nurses
Physician Assistants
Physicians

Single Health Care Delivery Organizations

Unspecified

Either male or female

Unspecified

See "Rationale" field.

See "Rationale" field.

See "Rationale" field.

Unspecified

• Pressure ulcers can increase nursing time up to 50%, and are very costly in time and resources.
• Every year, pressure ulcers affect more than one million acute care and nursing facility patients. Costs associated with treatment exceed one billion dollars annually. Within this total, more than 355 million dollars is spent on pressure ulcer treatment in long-term care settings. Lawsuit claims per occupied bed have increased at an annual rate of 14 percent, while the average court settlement has risen 250,000 dollars.

• American Medical Directors Association. Tool kit for implementation of the clinical practice guidelines for pressure ulcers [binder]. Columbia (MD): American Medical Directors Association (AMDA); 2004. various p.

Getting Better

Effectiveness

Users of care only

All patients in the facility who have a pressure ulcer or pressure ulcer risk

Patients associated with provider

Inclusions
All patients who have a pressure ulcer or pressure ulcer risk

Exclusions
Unspecified

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Institutionalization

Time window is a single point in time

Inclusions
Number who have pressure ulcer or pressure ulcer risk with documented* periodic assessment for specific risk factors

*Note: "Documentation" refers to whether a procedure/discussion was indicated/done or not indicated/not done.

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Institutionalization

Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Percentage of patients with a pressure ulcer or pressure ulcer risk with documented periodic assessment for specific risk factors.

American Medical Directors Association

There was no funding for the development of the measures. However, Ross Products Division of Abbott Laboratories did provide funding for the Pain Management Guideline Implementation Tool Kit.

Medical Directors, Physicians, Pharmacists, Registered Nurses, Advanced Practitioners, Nursing Home Administrators, Registered Dieticians, Wound Care Specialist

None

Measure was not adapted from another source.

2004 Sep

This is the current release of the measure.

• American Medical Directors Association. Tool kit for implementation of the clinical practice guidelines for pressure ulcers [binder]. Columbia (MD): American Medical Directors Association (AMDA); 2004. various p.

This NQMC summary was completed by ECRI on June 27, 2005.

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.