Avoiding and Managing Pressure Injuries in Nursing Facilities

June 21, 2024

Hello DON’s and Nursing, Let’s avoid F tag 686.

What is a Pressure Ulcer?

Pressure ulcers, also known as bedsores or pressure injuries, are localized damage to the skin and underlying tissue, usually over a bony prominence, as a result of prolonged pressure, shear, or friction. They can cause significant pain, infection, and other complications in residents of nursing homes.

Requirements and CMS Guidance:

The Centers for Medicare & Medicaid Services (CMS) provides detailed guidance for the prevention and treatment of pressure ulcers in the State Operations Manual, Appendix PP - Guidance to Surveyors for Long Term Care Facilities, F-Tag 686.

Key points to consider:

1. Assessment:

- Conduct a comprehensive skin assessment for all residents upon admission and regularly thereafter.

- Identify risk factors using a standardized tool like the Braden Scale.

2. Care Planning:

- Develop a care plan based on the resident’s risk assessment.

- Include specific interventions to prevent pressure ulcers, such as repositioning schedules, skin care protocols, and nutritional support.

3. Prevention:

- Implement preventive measures such as frequent repositioning, use of pressure-relieving devices, and maintaining skin hygiene.

- Educate staff and residents about the importance of pressure ulcer prevention.

4. Treatment:

- Provide appropriate treatment for existing pressure ulcers, including wound care, infection control, and pain management.

- Regularly reassess the wound and adjust the care plan as needed.

5. Documentation:

- Maintain accurate and detailed documentation of assessments, care plans, interventions, and outcomes.

Example of Non-Compliance:

A nursing home was cited for F-Tag 686 when a resident developed a Stage 3 pressure ulcer on their sacrum.

The surveyors found that the facility failed to:

- Conduct a timely and comprehensive skin assessment.

- Develop and implement an adequate care plan.

- Reposition the resident frequently enough to prevent pressure ulcers.

What the facility could have done to avoid the citation for Pressure Injuries

Step-by-Step Plan to Prevent Pressure Ulcers:

1. Initial Assessment:

- Perform a thorough skin assessment upon admission and weekly based on your facility policy

- Utilize a standardized risk assessment tool to identify residents at risk.

2. Care Plan Development:

- Create an individualized care plan for each at-risk resident.

- Include specific, evidence-based interventions tailored to the resident’s needs.

3. Staff Training:

- Provide ongoing education and training for all staff on pressure ulcer prevention.

- Ensure staff understand how to use assessment tools and implement care plans.

4. Repositioning Schedule:

- Establish a repositioning schedule for all at-risk residents.

- Document each repositioning to ensure compliance.

5. Nutritional Support:

- Assess residents’ nutritional status and provide necessary supplements or dietary modifications.

- Monitor and document residents' intake and nutritional improvements.

6. Skin Care Protocols:

- Implement and follow skin care protocols, including the use of moisturizers and barrier creams.

- Inspect the skin daily for early signs of pressure damage.

7.Pressure-Relieving Devices:

- Use specialized mattresses, cushions, and pads to relieve pressure.

- Ensure devices are used correctly and consistently.

8. Regular Monitoring and Reassessment:

- Conduct regular skin assessments and reassess risk factors at least weekly.

- Update care plans based on reassessments and changes in the resident’s condition.

9. Wound Care Management:

- Follow evidence-based protocols for the treatment of existing pressure ulcers.

- Involve a wound care specialist for advanced cases.

10. Documentation and Quality Improvement:

- Maintain accurate and comprehensive records of assessments, interventions, and outcomes.

- Regularly review documentation to identify trends and areas for improvement.

- Implement a quality improvement program focused on pressure ulcer prevention and care.

I recommend to follow these guidelines and implement a robust program to prevent and reduce the incidence of pressure ulcers and improve the quality of care for our seniors

Reference and useful links

1. Centers for Medicare & Medicaid Services (CMS). (2023). State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities. Retrieved from [CMS.gov](https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf)