Pressure injuries, also known as pressure ulcers and bedsores, are a significant concern in nursing facilities, particularly among residents with limited mobility. The development of pressure injuries can be a reflection of the quality of care a resident receives, making it crucial for nursing facilities to monitor and improve their preventive measures. In this context, understanding the long stay and short stay pressure ulcer/injury Quality Measures (QM) is essential for staff, residents, and their families.

What are Pressure Injuries?

Pressure injuries are injuries to the skin and underlying tissue resulting from prolonged pressure on the skin. They commonly develop on bony areas of the body such as the heels, ankles hips, and tailbone. Pressure injuries can range in severity from mild, non-blanchable reddening of the skin to severe tissue damage extending into muscle and bone. They can cause significant pain, lead to serious infections, and impact a patient’s overall health and quality of life.

Long Stay Pressure Ulcer/Injury QM

“Long stay” is defined as an episode with cumulative days in the facility (CDIF) greater than or equal to 101 days as of the end of the target period. The long stay QM is Percent of Residents with Pressure Ulcers. This measure uses MDS data from Section M and captures the percentage of long stay residents with Stage II-IV or unstageable pressure ulcers and replaced the Percent of High-risk Residents with Pressure Ulcers measure on October 1, 2023. This measure has been frozen since April and will remain so until January 2025. Therefore, Five-star will continue to display the “high-risk” measure until January 2025.

Short Stay Pressure Ulcer/Injury QM

“Short stay” is defined as an episode with CDIF less than or equal to 100 days as of the end of the target period. The short stay QM is Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury. This QM is calculated using the SNF Quality Reporting Program (QRP) measure and reports the percentage of Medicare Part A SNF stays with a Stage II-IV or unstageable pressure ulcer due to slough/eschar, non-removable dressing/device, or deep tissue injury, that are new or worsened since admission.

Importance of Quality Measures

The pressure injury Quality Measures are vital for several reasons:

      • Improving Resident Outcomes: By monitoring and addressing pressure injury development, SNFs can significantly improve resident outcomes, reduce pain and suffering, and prevent complications such as infections.
      • Enhancing Quality of Care: Quality Measures help to identify areas where facilities can enhance their care practices, leading to overall improvements in the quality of care provided to residents.
      • Accountability and Transparency: These measures promote accountability and transparency in SNFs. They enable residents and their families to make informed decisions about where to seek care and encourage facilities to maintain high standards.
      • Regulatory Compliance: Many regulatory bodies, including CMS, use QMs as part of their assessment and reimbursement processes. Compliance with these measures is essential for facilities to receive funding and maintain their accreditation.

Strategies for Prevention and Improvement:

To effectively prevent and manage pressure injuries, SNFs can implement several strategies:

      • Regular Skin Assessments: Conducting routine skin assessments helps identify early signs of pressure ulcer development, allowing for timely intervention
      • Pressure-Relieving Devices: Using specialized mattresses, cushions, and other devices can help to reduce pressure on vulnerable areas.
      • Repositioning: Regularly repositioning patients, especially those with limited mobility, helps distribute pressure more evenly and reduces the risk of pressure injury development.
      • Nutrition and Hydration: Ensuring residents receive adequate nutrition and hydration supports skin health and promotes healing.
      • Staff Education and Training: Providing ongoing education and training for direct care staff on pressure injury prevention and management is crucial for maintaining high-quality care standards.

Since these measures use MDS data to inform the measure calculations, regular education on RAI requirements and MDS coding accuracy should be in place as part of effective Quality Measure management.

Proactive can support your quality care and compliance goals:

      • Make plans to attend Supportive Documentation for Pressure Ulcer Prevention & Management on July 16, 2024
      • Join us on August 13, 2024 for the webinar session Immediate Jeopardy Risk: Pressure Ulcers with a review of recent IJ level deficiencies related to Pressure Ulcers and how to avoid them.
      • Looking to brush up on MDS coding and QMs or have new staff in need of training? Join Proactive August 6-8, 2024 for 15 contact hours of live virtual MDS orientation training with expert trainers. Extensive resources and opportunities for Q&A will be provided in this MDS orientation that introduces critical clinical assessment, care planning, and MDS concepts impacting facility reimbursement, QMs, and regulatory compliance.
      • Contact us to learn more about nurse consultant support options for clinical program review and QA monitoring assistance.


Written by Eleisha Wilkes, RN, GERO-BC, RAC-CTA, DNS-CT
Clinical Consultant

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