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Pressure ulcers in Ontario nursing homes (2024)

Table of Contents

Introduction

Understanding pressure ulcers in long-term care homes is of critical importance due to their significant impact on the health and quality of life of residents. Pressure ulcers, also known as bedsores or decubitus ulcers, are injuries to the skin and underlying tissues, primarily resulting from prolonged pressure on the skin. These injuries frequently occur over bony areas such as the heels, ankles, hips, and tailbone, and are especially common among individuals who are immobile or confined to a bed or chair.

The severity of pressure ulcers can range widely, from mild skin reddening to deep wounds that penetrate into muscle and bone, presenting substantial health risks. These wounds can develop rapidly and are notably difficult to heal, particularly in older adults or those with conditions that compromise blood flow, such as diabetes.

A variety of factors contribute to the risk of developing pressure ulcers. Advanced age often brings a decline in nutritional and mental health, reduced mobility, sensory deficits, incontinence, and diminished skin elasticity, all of which can increase vulnerability. In nursing home residents, specific risks include non-blanchable erythema, hypotension, contractures, and a history of cerebral vascular accidents. Notably, those with urinary incontinence may have a somewhat reduced risk of pressure injuries, possibly due to more frequent movements and repositioning during care.

The prevalence and management of pressure ulcers serve as vital indicators of the quality of care provided in long-term care facilities. Effective prevention and treatment strategies are essential and include regular repositioning of residents, the use of pressure-relieving devices, diligent skin care, and nutritional support. Monitoring these ulcers is crucial for identifying risk factors, implementing timely interventions, and assessing the effectiveness of care strategies.

Definition of "worsened pressure ulcers"

The measurement of worsened pressure ulcers in long-term care facilities focuses on the percentage of residents whose stage 2 to 4 pressure ulcers have deteriorated since their previous assessment. This metric is a critical indicator of the quality of care regarding the prevention and management of pressure ulcers, which are areas of damaged skin caused by prolonged pressure often experienced by individuals with limited mobility.

The numerator for this measurement includes residents who had a stage 2, 3, or 4 pressure ulcer within the seven days prior to their target assessment and whose ulcers have increased in severity by the time of this assessment. The denominator consists of all residents who have undergone valid assessments during the specified timeframe.

Exclusions from this measure are residents who already had a stage 4 pressure ulcer during their prior assessment, as their condition cannot worsen beyond this stage. The clinical guidelines stipulate that pressure ulcers should be staged according to the extent of tissue damage observed.

In terms of performance, a lower percentage is preferable as it indicates fewer cases where pressure ulcers have worsened, reflecting better care practices in preventing and managing these conditions.

Ontario nursing homes with highest percentage of residents with worsened pressure ulcers

Below are five top nursing homes with the highest percentage of residents whose stage 2 to 4 pressure ulcer worsened since the previous assessment.

  • 🥇  Sandfield Place ranks first at 9.3% for the highest percentage of residents with worsened pressure ulcers
  • 🥈  Fairfield Park ranks second at 8.6% for the highest percentage of residents with worsened pressure ulcers
  • Saint-Louis Residence ranks fourth at 7.7% for the highest percentage of residents with worsened pressure ulcers
  • Listowel Nursing Home ranks fifth at 7.6% for the highest percentage of residents with worsened pressure ulcers

Susceptibility of body regions to pressure ulcers

Pressure ulcers, a prevalent issue in long-term care settings, commonly develop in specific body regions due to prolonged pressure and compromised blood flow. Certain areas are particularly susceptible:

  • 👴  Back of the Head: Ulcers at the back of the head typically arise when individuals remain in a lying position for extended periods. The skin overlying the occipital bone is especially vulnerable as it supports the weight of the head, leading to increased pressure and potential skin breakdown.
  • 🤷  Shoulders: The shoulder area, including the shoulder blades, is at risk due to continuous pressure when individuals lie on their backs or sides. This sustained pressure can impede blood flow to the skin and underlying tissues, heightening the risk of ulcers.
  • 💪  Elbows: Ulcers on the elbows often occur because of the bony structure of the elbow and the thin layer of skin and padding overlying these bones. When a person remains in one position for too long, the pressure exerted can lead to significant tissue damage and skin breakdown.
  • 🦵  Hips: The hips, particularly the trochanters, are common sites for pressure ulcers in those confined to beds or wheelchairs. The substantial pressure exerted on this area when lying on either side can make these ulcers deep and difficult to treat.
  • 🪑  Lower Back and Buttocks: The sacral and coccygeal areas—including the lower back and buttocks—are highly prone to ulcer formation. These areas bear much of the body's weight when a person is seated or lying down, which significantly increases the risk of tissue damage.
  • 🧎  Inner Knees: Pressure ulcers on the inner knees can develop when the legs are pressed together or against a bed. The skin over the knee joint is particularly sensitive as it lacks substantial protective muscle or fat, making it susceptible to ulcers under sustained pressure.
  • 🦶  Heels: Heels are a frequent site for pressure ulcers, primarily because they lack significant soft tissue padding. This makes them highly vulnerable to damage from sustained pressure or weight in a bed-bound position.

Considerations for choosing a nursing home

When evaluating nursing homes, the rate of residents with worsened pressure ulcers is a critical indicator that warrants thorough consideration. A high percentage of residents experiencing worsening pressure ulcers can signal several alarming issues related to the overall quality of care provided in the facility.

Primarily, this metric suggests potential deficiencies in the preventative care protocols implemented by the nursing home. Effective prevention of pressure ulcers typically involves a combination of regular repositioning of residents, meticulous skin care, and immediate response to the initial signs of skin breakdown. These measures are vital for residents who may be immobile or have limited mobility, as they are at a higher risk of developing such conditions. The absence or inadequate execution of these strategies can be indicative of deeper issues within the facility's operational standards.

Often, the root of this problem can be traced back to staffing issues. Insufficient staffing levels or inadequately trained personnel can lead to neglect in essential care practices. This shortfall not only prevents the effective monitoring and management of early signs of pressure ulcers but also impacts the facility's capacity to carry out routine preventive measures. The implications of such oversight are severe, exposing residents to increased discomfort, pain, and the risk of serious infections. In extreme cases, these conditions can escalate to life-threatening complications, profoundly diminishing the affected residents’ quality of life.

Furthermore, the presence of such issues points to a failure in adhering to established protocols for pressure ulcer management, which are designed to uphold a standard of care that protects resident well-being and dignity. Prospective residents and their families should thoroughly investigate these aspects when choosing a facility. This includes inquiring about staff training programs, staffing ratios, and the specific preventive measures employed to safeguard against the development and worsening of pressure ulcers.

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