Bed Sores And Pressure Ulcers In Nursing Homes

Skin Risk

Charts should show skin checks, a Braden or similar risk score, immobility level, moisture, nutrition, cognition, and any prior wound history. Missing or infrequent skin checks are one of the first gaps a case review looks for, since risk scoring is supposed to happen on a set schedule rather than only after a wound already appears.

Prevention Steps

Turning and repositioning schedules, pressure-relief surfaces, nutrition care, incontinence care, and wound-nurse orders show what should have happened once a resident was identified as at risk. A facility that documents a risk score but never adjusts the care plan afterward has a gap worth examining.

Escalation

Infection, odor, drainage, fever, sepsis markers, wound debridement, a hospital admission, or delayed notice to the physician can turn a single wound into a case review that spans the resident’s entire stay. The timeline between when a wound was first noted and when it was escalated to a physician often becomes the central question.

Pressure Wounds By The Numbers

A national CDC study found that about 159,000 U.S. nursing-home residents have a pressure ulcer of some stage, according to the CDC NCHS Data Brief 14. CMS separately tracks a long-stay pressure ulcer quality measure for every certified nursing home, which is one reason a facility’s own record on this measure is checkable against a national benchmark, per the CMS quality measures program.

Wounds are staged, dated, and charted under standard nursing practice. Wound notes should show stage, size, location, and treatment over time, consistent with the documentation approach described in the AHRQ On-Time Pressure Ulcer Prevention program.

Records To Request Or Preserve

Pressure-wound cases are fact-specific, and some wounds can develop despite proper care. The review asks whether the facility recognized the resident’s risk, followed the written care plan, escalated changes in the wound promptly, and documented what happened at each stage of care.

The records that matter most are the ones generated closest to the wound itself: nursing notes at the time the wound was first observed, the risk assessment on file before that date, and any communication with the family or the attending physician once the wound was identified. A gap in any one of those records is often the first thing a case review flags.

Photograph And Date The Wound

Save wound photos, discharge papers, medication records, and the facility’s explanations. Dated photographs are especially useful because they let a reviewer track how a wound progressed against what the chart says the facility was doing about it during the same period.