Nursing Home/Hospital Pressure Ulcer Project

Thirteen Oregon nursing homes and eight hospitals are participating in the Nursing Home/Hospital Pressure Ulcer Project, a Medicare-funded initiative that recognizes the importance of a cross-setting approach to pressure ulcer prevention and care.

Participating nursing homes and hospitals received initial assessments as well as an analysis of how closely their practices adhered to Oregon Best Practices defined in the statewide Transitional Care & Pressure Ulcers Toolkit Project. Many facilities have developed quality improvement projects based on the assessments.

Quality improvement communities

Project participants meet periodically in “cluster workgroups” so that hospitals and nursing homes who refer patients/residents to each other can work together to implement the handoff dataset, a tool developed in the Transitional Care & Pressure Ulcers Project to ensure that critical information accompanies a resident/patient who is transferred between settings.

Patient resident safety culture surveys

Acumentra Health is administering the Agency for Healthcare Research and Quality (AHRQ) Resident Safety Culture Surveys to participating nursing homes. The surveys ask for staff opinions about the culture of resident safety in their facility. Survey results will help site leaders evaluate specific safety interventions and conduct internal and external benchmarking.

Tools and resources

Positioning and pressure points materials for caregivers

• Pocket card (PDF)
• Wall poster (8.5 x 11, PDF)
• Nursing Home Quality Briefs e-newsletter

Hand hygiene

• Video training and self-assessment tool

Advancing Excellence in America's Nursing Homes campaign

• AE pressure ulcer materials

Transitional Care & Pressure Ulcers Project Toolkit

In 2007, the Oregon IHI Network and the Oregon leaders of Advancing Excellence in America’s Nursing Homes formed a Joint Committee to plan and develop cross-setting interventions for transitional care, with an initial focus on pressure ulcers.

The Joint Committee assembled a cross-setting, multidisciplinary Advisory Panel to identify Oregon Best Practices for preventing or minimizing pressure ulcers in hospitals, nursing homes, community-based long-term care, and home health agencies. The Panel also developed a handoff dataset of pressure ulcer-related information that would accompany residents/patients in transition between settings. These materials were pilot-tested in several Oregon communities.

Go to toolkit