View My Goals

Explore Goal

Deciding what you want to change and communicating that intention is the first step of the quality improvement cycle. This page provides a general description of the goal and its benefits to share with your team.

A pressure ulcer or bed sore is an injury to the skin caused by constant pressure over a bony area which reduces the blood supply to the area. Pressure can be caused by the resident lying too long in one position or by tubing or devices that press on the skin. Pressure ulcers can be dangerous and painful for a resident, in part because broken skin can introduce infection into the body. If untreated, pressure ulcers can deepen to the point where they expose the bone. Deeper ulcers may be hard to heal or may not heal at all. Sometimes, pressure ulcers can lead to serious medical complications and even death. Even if pressure ulcers heal, the skin never returns to normal and will be at higher risk for future pressure ulcers.

  • How Does Pressure Ulcer Reduction Benefit Residents?

    Residents experience less pain.

    Residents experience fewer infections.

    Residents experience better quality of life by avoiding the negative effects of pressure ulcers.

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  • How Does Pressure Ulcer Reduction Benefit Long-term Care Staff?

    Staff members are more likely to experience enhanced job satisfaction.

    Preventive care is ultimately less time consuming for staff than the treatments and dressings that are necessary when pressure ulcers develop.

    Staff improves overall quality of care through prevention and early recognition and treatment of pressure ulcers.

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  • How Does Pressure Ulcer Reduction Benefit Long-term Care Communities?

    Providers have less cost associated with dressing supplies for pressure ulcers.

    Providers have a better image in the community due to satisfied residents, families, and staff.

    Providers have more successful surveys, improved quality measures and a better overall rating by CMS and consumers.

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Step 2 – Tracking Tool  >

Tracking Tool

The Campaign Tracking Tools allow you to document your work, monitor outcomes and the processes related to your outcomes. To achieve a data-driven quality improvement project, collect data for several months to establish a solid baseline and set a target for your improvement; then continue collecting data -- charts within the workbooks and trend graphs on the website provide you and your team with the feedback you need to determine if the changes you are making are being fully implemented and if they are having the expected impact on your outcomes. Keep your workbook up-to-date on a daily or weekly basis and look at data often to support a rapid cycle quality improvement project. Download the data tracking tool and collect data for a month or so to determine your starting point.

Questions? Contact the NNHQI Campaign Help Desk:

Before you start, read our Tip Sheet on Testing Change & Starting Small (PDF).

Step 3 – Examine Process  >

Examine Process

This set of probing questions will help you evaluate your current processes and provide guidance for ways to make improvements.

  • Why is our rate of pressure ulcers high?

    • Has there been a change in the number/kind of pressure ulcers?
    • What is driving our high pressure ulcer rate?
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  • What groups are affected? Are they:

    • Long stay or short stay?
    • Rehabilitation residents?
    • On the same unit?
    • Being admitted with pressure ulcers?
    • Developing pressure ulcers in our nursing home?
    • Experiencing an acute change in condition?
    • Immobile?
    • At risk for developing pressure ulcers?
    • Actively dying?
    • On an intervention such as a brace or splint?
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  • Processes and Resources to Consider

  • What types of assessments are we using?

    • Are we doing monthly risk assessments?
    • Are we doing weekly skin assessments?
    • Are we doing daily assessments?
    • Are we doing follow-up assessments consistently?
    • Do we use the same assessment tool across the nursing home?
    • Do we provide feedback to "admitting" providers about pressure ulcers?
    • Is the assessment part of the care plan?
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  • What techniques and treatments are we using?

    • Have we considered adding additional interventions?
    • Do we share skin assessment/risk information proactively when transferring a resident out of the nursing home?
    • Is staff providing prevention measures to high-risk residents?
    • Are prevention interventions evidence based?
    • Are our wound treatments evidence based?
    • Are we involving an interdisciplinary team in the assessment and care of wounds?
    • Do we customize the interventions we use to each individual’s needs?
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  • Are we evaluating what we are doing?

    • How do we know our interventions are effective?
    • Does the staff assess outcomes of interventions?
    • Do we monitor wounds weekly?
    • Do we use a standard tool to monitor and document the status of wounds?
    • Are we evaluating the effectiveness of wound treatments?
    • Are we assessing and treating underlying causes of wounds?
    • Is our documentation consistent with the language of MDS and other required assessment tools?
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  • What education are we providing?

    • Are staff well educated on the use of our tools?
    • Do staff follow the procedures for risk assessment?
    • Do staff follow the procedures for skin assessments?
    • Are staff well educated on wound assessments?
    • Are staff well educated in the treatment of wounds?
    • Are we educating family and friends about pressure ulcers and what causes them and how the skin breakdown can be treated?
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Step 4 – Create Improvement  >

Create Improvement

The Science of Change

  • The Circle of Success is a quality improvement framework and a guide to finding the resources you need on the website.
  • Quality Improvement Methods are evidence-based approaches for creating systemic change. This collection includes quick-start instructions, templates, and mini-videos.
Toolkits & Packages
Website New  Wound Management Best Practice Intervention Package - This package brings together evidence-based practices and tools from leading expert organizations, such as Wound, Ostomy, and Continence Nurses Society (WOCN); National Pressure Ulcer Advisory Panel (NPUAP); International Skin Tear Advisory Panel (ISTAP); and Centers for Medicare & Medicaid Services (CMS).
Website AHRQ's On-Time Pressure Ulcer Prevention Toolkit is for long term care providers with electronic medical records. An outcome evaluation showed a 59 percent reduction in the incidence of pressure ulcers when at least three of these reports were integrated into care planning processes.
Risk Assessment Tools & Education
Adobe PDF CNA Skin Assessment Report Tool for CNAs to document skin assessment and facilitate information sharing with RN. Shared with permission from Susan Duong, RN.
Adobe PDF The Braden Risk Assessment Tool is a tool to help assess a patient's risk of developing a pressure ulcer.
Adobe PDF Try This Issue 5 - Predicting Pressure Ulcer Risk. The article and video can be accessed by clicking the link.
Website Assessments and Best Practices in Care of Older Adults.
Prevention and Healing
Website AHRQ's On-Time Pressure Ulcer Prevention Toolkit is for long term care providers with electronic medical records. An outcome evaluation showed a 59 percent reduction in the incidence of pressure ulcers when at least three of these reports were integrated into care planning processes.
Website The National Pressure Ulcer Advisory Panel (NPUAP) has provided an online description of pressure ulcer prevention strategies.
Adobe PDF Braden Prevention Strategies by Level of Risk - Prevention strategies are appropriate at all levels of risk. View information both on general strategies, as well as protocols specific to the level of risk.
Pressure Ulcer Staging and Documentation
Website The National Pressure Ulcer Advisory Panel (NPUAP) has provided written definitions and pictorial descriptions of all stages of pressure injury.
Adobe PDF Telligen has created a reference card that compiles NPAUP's guidelines and illustrations on one page, and a quick reference to measurement and documentation on the next.
Website AHRQ's Pressure Ulcer Assessment is a comprehensive form for documenting all wound characteristics as well as information on wound treatment and prevention.
Website The PUSH Tool helps define that status of a pressure ulcer. Is it getting better, staying the same, getting worse or has it healed.
Pressure Ulcer Management
Adobe PDF This clinical practice guideline was developed by AMDA and provides tips/resources for the overall prevention and management of pressure ulcers.
Adobe PDF A detailed description of treatment options for pressure ulcers as collated by the National Pressure Ulcer Advisory Panel (NPUAP).

Step 5 – Engage  >


Engaging stakeholders creates a robust and successful quality improvement project. Use these fact sheets to start the conversation and encourage everyone to be involved. A story board is a wonderful, visual way to engage your community in the project, keep everyone in the know about new changes that are being tested, and share your challenges and successes along the way.

Story Board Guide
Adobe PDF Storyboard guide from QAPI
Use this guide to create a compelling poster to keep your community engaged in your project, monitor your progress, and celebrate your success. Print outcome trend graphs from your Campaign account to document your change!
Pressure Ulcers Fact Sheets
Adobe PDF Leadership Fact Sheet
Adobe PDF Staff Fact Sheet
Adobe PDF Consumer Fact Sheet

Step 6 – Monitor & Sustain  >

Monitor & Sustain

Once you make a change or an improvement, it’s important that you continue to collect and submit your data to ensure your improvements are working.

Step 7 – Celebrate Success  >

Celebrate Success

Too often we let accomplishments pass by without notice because we are already moving on to the next step. But, it's important to take a moment to celebrate accomplishments, big and small.

A celebration program can create a spirit of community in your nursing home. Use visible awards such as certificates, plaques and other tangible rewards that can be proudly displayed. Try giving a spontaneous award from time to time to acknowledge people who are going the extra mile.

More resources on their way. Please check back soon.

Back to Goals  >

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