New or worsening pressure ulcers can hurt your 5-star rating—learn how accurate coding and early intervention can protect your score.
In today’s dynamic post-acute care environment, short stay quality measures have become vital indicators of a skilled nursing facility’s commitment to high-quality, resident-centered care. As part of our ongoing series, “Quality Measure Drill Down”, we continue to explore how to effectively analyze data to ensure MDS coding accuracy, while also examining the clinical practices that influence a facility’s overall Quality Measure star rating."
We encourage readers to revisit the previous issue of Ask Amanda, where we addressed the short-stay quality measure of newly prescribed antipsychotic medication use after admission and various ways to appropriately explore alternative approaches.
As we continue our series on “Quality Measure Drill Down,” the focused short-stay quality measure of the month is the percent of residents with pressure ulcers/injuries that are new or worsened. This is a Skilled Nursing Facility Quality Reporting Program (SNF QRP) measure, meaning that information will be reviewed over a 12-month period and may include multiple Part A stays.
This quality measure looks at residents who admitted with no pressure ulcer coded on the Admission or 5-day MDS and then has a pressure ulcer coded on a discharge assessment, OR residents who were admitted with a lower stage pressure ulcer coded on the Admission or 5-day MDS and then had a pressure ulcer coded at a higher severity on discharge.
Examples of how this quality measure would be triggered:
- If a resident does not have a pressure ulcer coded on the admission and/or 5-day MDS but has a stage II pressure ulcer coded on the discharge MDS.
- If a resident has a stage II pressure ulcer coded on the Admission and/or 5-day MDS but has a stage III pressure ulcer coded on the discharge MDS.
- Note, if a resident has a stage II pressure ulcer coded on the Admission and/or 5-day MDS and has that same stage II pressure ulcer coded on the discharge MDS, they will not trigger, because it has not worsened and is not new.
To appropriately drill down on this measure:
- Ensuring MDS accuracy.
- Determine the etiology of the wound is accurate to support coding of pressure ulcer.
- Confirm the pressure ulcer was present during the look-back period of the assessment.
- Determine that appropriate interventions have been initiated for the care of the pressure ulcer, such as:
- Physician, resident, and resident representative have been notified.
- Formal pressure ulcer risk assessments (Braden, Norton) are completed quarterly or per facility protocol.
- Facility protocol is consistently implemented to provide pressure ulcer treatment, positioning, and the use of positioning devices.
- Pressure ulcers are assessed weekly or per facility protocol for proper healing with physician intervention when pressure ulcer does not successfully respond to treatment.
- Direct care staff are aware of positioning devices and rounds are in place to confirm the use of devices as care planned.
- Ongoing education to ensure competency in the care and prevention of pressure ulcers.
- Referrals and/or interventions from occupational and/or physical therapy are in place to address positioning as appropriate.
When it comes to skin integrity, accurate and timely documentation at admission is your best line of defense. Establishing a clear, consistent process for conducting comprehensive skin assessments upon entry ensures that any existing wounds or skin issues are identified and recorded before they become a facility-acquired wound.
A well-documented admission skin check not only supports high-quality care but also protects your team from assuming accountability for pre-existing conditions. The last thing you want is to “own” a wound that was present on day one but went undocumented.
Having a structured workflow, using validated tools, and involving the interdisciplinary team from the start helps ensure no detail is overlooked—and that your documentation stands up to scrutiny.
The Resident-Level Quality Measure Report, available in IQIES, is an invaluable tool for monitoring which residents are triggering specific quality measures. By leveraging this report alongside the tools mentioned above, you can effectively drill down into the data to understand the underlying factors for each resident identified—supporting targeted, data-driven care interventions.
Stay tuned as we continue our “Quality Measure Drill Down” series. Next month, we’ll take a closer look at long-stay quality measures and what they mean for your care strategies.
As the post-acute care landscape continues to evolve, your voice matters more than ever. We invite your questions, concerns, and insights as we work together to find practical, effective solutions that support you, your facility, and—most importantly—your residents in achieving the best possible outcomes.
Have a question or topic you'd like us to explore? It just might be featured in an upcoming article!
