Quality Indicators for the Care of Pressure Ulcers in Vulnerable Elders

Pressure ulcers are areas of local tissue trauma, usually developing where soft tissues are compressed between bony prominences and any external surface for prolonged time periods. Pressure ulcers can lead to pain and disfigurement and slow recovery from comorbid conditions, interfere with intermediate and basic activities of daily living, and predispose to osteomyelitis and septicemia. They are also strongly associated with longer hospital stays and with mortality, in hospitals and nursing homes. Frailty and preexisting illness predispose to pressure ulcers and adverse outcomes. Bed-bound individuals may form pressure ulcers in as little as 1 to 2 hours, whereas those who are confined to chairs and who cannot move voluntarily may form pressure ulcers in even less time because of the greater relative force on their skin. In hospitalized vulnerable elders (VEs) of all ages, the prevalence of pressure ulcers has been estimated at 15%. The incidence of new lesions varies widely according to clinical situation; the highest rates are found in VEs undergoing orthopedic procedures (9-19% incidence) and quadriplegics (33-60% incidence). In nursing homes, prevalence estimates vary from 2% to 24%. In home healthcare settings, the prevalence of pressure ulcers has been estimated to be 6% to 9%. In outpatient settings, the prevalence of pressure ulcers is estimated to be 1.6%. This article investigates the relationship between processes and outcomes of care, identifies potential quality indicators (QIs) that may be used to assess the treatment of VEs with pressure ulcers, and reviews the available evidence in support of these indicators. METHODS: A total of 281 articles were considered in this review: 18 identified through a Web search, 134 through reference mining, and 129 through the Assessing Care of Vulnerable Elders (ACOVE)-3 literature searches. RESULTS: Of the 15 potential QIs, the expert panel process judged 13 to be valid; two were rejected. The literature summaries that support each of the indicators judged to be valid in the expert panel process are described.