Pressure ulcers are areas of tissue damage or necrosis that develop due to pressure over a bony prominence; the reported incidence rate for pressure ulcers in long term care facilities varies from 0% to 31%.31 Severe pressure sores are a major source of morbidity and mortality in nursing home residents (including pain, infection, disfigurement, and interference with activities of daily living).18 The estimated costs of treating a pressure ulcer range from $4000 to $40,000 for newly developed ulcers. A specific goal of Healthy People 2010 is to reduce the prevalence of pressure ulcers in nursing homes by 50%.32
Because pressure ulcers are directly observable, the documentation of pressure ulcers is relatively straightforward. Additionally, risk factors for the development of pressure ulcers are well described. Therefore, determination of quality of care based on pressure ulcer data can be related not just to the outcome of pressure ulcer development, but also to processes of care that are known to reduce the risk of pressure ulcer development.