THE OCCURRENCE OF PRESSURE ULCERS IN 3 NURSING-HOMES

Background: In the 27 nursing homes located within the Veterans Affair s (VA) Central Region, the proportion of residents with pressure ulcer s in 1986 varied from 2% to 16%. Three of these nursing homes were sel ected for study: nursing home A from the highest prevalence quintile, B from close to the median, and C from the lowest quintile. Methods: T wo indicators of pressure ulcer occurrence were calculated: the point- in-time prevalence of bedsores and the percentage of residents who wer e free of pressure ulcers at the beginning of a six-month study period but who had bedsores six months later. Data were also collected in ea ch nursing home to determine the bedsore status at the time of admissi on and the resident's location if and when a bedsore began. Results: T he three institutions were generally similar in available measures of casemix and severity of illness. The ratio of nursing and medical pers onnel to residents was 29% - 76% lower in nursing home A than in B or C. In nursing home A, the turnover of nursing personnel was about twic e as rapid as that in B or C. In each institution the pressure ulcer s tatistics showed little variation from one six-month period to another . The average rates in nursing home A were 15.3% for prevalence and 10 .3% for the six-month conversion from bedsore-negative to bedsore-posi tive status. The average rates in facilities B and C were, respectivel y, 6.9% and 3.5% for prevalence and 4.7% and 4.2% for the six-month co nversion from negative to positive status. Furthermore, the number of new bedsores that developed during uninterrupted nursing home residenc e, per 100,000 resident days, was 36.5 in A, 10.8 in B, and 2.1 in C. Conclusions: The pressure ulcer statistics in nursing homes B and C we re consistently superior to those in A. The interinstitutional differe nces could not be explained by the comparisons of scoring methodologie s and of casemixes that were made. It is hypothesized that more favora ble staffing patterns in B and C than in A contributed to more effecti ve prevention of bedsores in the former two institutions.