On-Time Quality Improvement Manual for Long-Term Care Facilities

Tool: Pressure Ulcer Incidence Data Collection

Directions:

• Complete the identification fields for Facility and Unit #.
• For each month, enter the unit census (indicate when calculated: first of month, end of month, midmonth, average daily census [ADC]).
• For each month, enter the number of new pressure ulcers Stage I through IV and Unstageable (in-house acquired in one column and outside acquired in another column):
  • Do not count existing pressure ulcers that developed in previous months.
  • Do not count existing pressure ulcers on residents new to the unit.
  • Include all newly acquired pressure ulcers. A single resident may have more than one newly acquired pressure ulcer.
  • If a resident has at least one in-house acquired and at least one outside acquired, the resident should be counted in both the in-house and outside totals.

Definition of pressure ulcer: Any sore/lesion caused by unrelieved pressure resulting in damage to underlying tissue and usually occurring over bony prominences (AHCPR, 1992*). Pressure ulcers most commonly occur over the coccyx or sacrum, heels, and trochanter. They also occur over any bony prominence or area exposed to pressure. Include Stages I through IV and Unstageable. Do not include vascular or diabetic ulcers and skin tears.

In-house acquired vs. outside-acquired (or present on admission or readmission) are to be determined according to CMS guidelines: if the ulcer is first observed within 24 hours of admission (regardless of state), it is present on admission. If it is first observed more than 24 hours after admission, it is in-house acquired.

Facility Name: __________________________________________________________________

Unit # (name): __________________________________________________________________

Completed by: _________________________________________________________________

Date: __________________________________________________________________________

Census was calculated (please circle):   First day of month     Middle of month      Last day of month      ADC

* Bergstrom N, Allman R, Carlson C, et al. Pressure ulcers in adults: prediction and prevention. Clinical practice guideline number 3. Rockville, MD: Agency for Health Care Policy and Research; 1992. AHCPR Publication No. 92-0047. Available at: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hsahcpr&part=A4409.

Return to Document