Skin assessment and pressure ulcer care in hospital-based skilled nursing facilities

The Minimum Data Set, a comprehensive assessment tool for nursing home residents, is used for clinical decision-making, research, quality improvement, and Medicare and Medicaid reimbursement. Within the Minimum Data Set, pressure ulcers and skin condition are evaluated. Because information about pressure ulcer prevalence and care in hospital-based skilled nursing facilities is sparse, a study was conducted to: a) determine pressure ulcer prevalence upon admission to hospital-based skilled nursing facilities in the state of Missouri, and b) ascertain methods of assessment, treatment, and documentation of skin and pressure ulcer care in these facilities. Prevalence data were obtained from analysis of the Minimum Data Set data, and a survey was conducted to obtain skin care practices. The vast majority of residents (96%) were admitted from acute care facilities, and pressure ulcer prevalence on admission was 18.4% +/- 8.0%. Seventy-seven percent (77%) of the 88 surveys mailed were returned. The Braden or Norton Scale for risk assessment is reportedly used by 55% of facilities; whereas, 35% use a facility-developed tool. Commonly reported pressure ulcer prevention/treatment interventions used include: dietitian referral, use of barrier ointments, and a written repositioning schedule. Incontinence management and minimizing the head of bed elevation were infrequently used. Nearly one-half (47%) of facilities reported daily reassessment and documentation of wound status, suggesting less-than-optimal, time-consuming wound care practices. Despite the limitations inherent in survey designs and the use of databases such as the Minimum Data Set, the results of this study suggest that pressure ulcers are a common problem in acute care and hospital-based skilled nursing facilities and research-based risk assessment, prevention, and wound assessment strategies have not been widely implemented. The results of this study provide a basis for developing educational programs and a guide for future research.