Quality in Focus: Treatment and Services to Prevent/Heal Pressure Ulcers. A multidisciplinary approach for resident safety.
CMS developed the Quality in Focus Program as a resource for all long-term care facilities in the nation to assist in promoting safe environments within LTC facilities and to educate the general public about why regulations in nursing facilities are seemingly strict and sometimes restrictive. Using Quality in Focus as the foundation, Polaris Group highlights F686 Treatment and Services to Prevent/Heal Pressure Ulcers, which is uniquely dependent on other areas of care in achieving compliance. 85% of Polaris Mock Surveys conducted in Q1 2025 reveal concerns with F686 and validate that when there are issues with the prevention of pressure ulcers, there are likely issues related to one or more of the following areas:
- F804 Nutrition
- F725 Sufficient staff
- F641 Comprehensive Assessments
- F677 ADL Care provided for Dependent Residents
- F697 Pain Management
- F675 Quality of Life
- F658 Services Meet Professional Standards
- F656 Care Plans
- F657 Care Plan Updates
- F684 Quality of Care
According to an article published in the National Institutes Of Health, 80% of pressure ulcers develop within 2 weeks of admission and 96% develop within 3 weeks of admission.
Preventing pressure ulcers has been a nursing concern for many years, as noted by Florence Nightingale in 1859, who stated, “if he has a bedsore, it is generally not the fault of the disease, but of the nursing.” Pressure ulcers are often associated with poor or non-existent nursing care, along with a failure of the entire health care team.
The prevention of pressure ulcers is a multidisciplinary approach and should be considered a resident safety goal. Mortality is associated with pressure ulcers, with rates as high as 60% for older persons within one year of hospital discharge. While pressure ulcers themselves may not cause death, they certainly contribute to the sequential decline in health status. Pressure ulcers can occur within 2 to 6 hours; therefore, the key to preventing pressure ulcers is to accurately identify at-risk residents quickly so that preventive measures may be implemented promptly.
Action Steps to F686 Compliance
Risk Assessments
- Use a structured risk assessment tool to identify residents at risk within the first 8 hours of admission.
- Refine the assessment by identifying additional risk factors, including existing pressure injuries and other diseases, such as diabetes and vascular problems.
- Repeat the assessment on a regular basis and address changes as needed.
- Develop a care plan based on the risk assessment. Prioritize and address identified issues.
Skin Care
- Inspect the skin upon admission and at least daily for signs of pressure injuries.
- Assess pressure points, temperature, and the skin beneath medical devices.
- Clean the skin promptly after episodes of incontinence, use skin cleansers that are pH balanced for the skin, and use skin moisturizers.
- Avoid positioning the resident on an area of pressure injury.
- Document accurately, notify PCP and responsible party, add interventions and update care plans immediately upon observation of new reddened areas.
Nutrition
- Use a valid tool to assess the resident’s risk of malnutrition.
- Refer at-risk residents to a registered dietitian or nutritionist for input.
- Assess the resident’s weight regularly, as well as the adequacy of oral, enteral, and parenteral intake.
- Provide supplemental nutrition as indicated, including Vitamins C, E, B12 and Zinc.
- Albumin levels should be checked regularly as appropriate.
Positioning and Mobilization
- Turn and reposition at-risk residents, if not contraindicated.
- Plan a scheduled frequency of turning and repositioning the resident.
- Consider using pressure-relieving devices when placing residents on any support surface.
- Consider the resident’s body size, level of immobility, exposure to shear, skin moisture and perfusion when choosing a support surface.
Monitoring, Training and Leadership Support
- Monitor the prevalence and incidence of pressure injuries.
- Educate and train all members of the interdisciplinary team. Make sure they are aware of the care plan and that all care is documented in the residents’ record.
- Ensure leadership support, oversight, and allocation of adequate resources.
Important Observations
- Using the Pressure Ulcer/Injury Critical Element Pathway, CMS directs surveyors to observe for the following to determine if facility practices are in place.
- Do all staff use appropriate infection control practices?
- Is there visible soiling of resident gowns/clothing?
- What does the overall care of the resident look like? i.e., face cleaned, facial hair shaved, hair washed, no odors in room, proper positioning, clean linens, fingernails trimmed and clean.
- Are meals provided timely and with the necessary assistance?
- Is there an active restorative program in place?
- Is there an adequate supply of clean linen?
- Is there a robust activity program that offers resident preferred activities, including weekends and/or evenings?
- Are showers given as scheduled?
- Are residents encouraged to eat meals in the dining room?
Creating a Team Approach
As a member of the management team, ask yourself if the culture created in your facility includes the true ‘team’ approach.
- Could your laundry worker identify improper positioning of a resident, and would they know that someone on the clinical team should be notified?
- Does your housekeeping staff know what to do when an air pressure mattress pump starts beeping when the room floor is being cleaned? Do they ignore it or tell someone?
- When a dietary team member picks up meal tickets and notices three pillows on the floor and none on the bed, do they know they play a role in helping prevent pressure injuries?
For further information on how your facility can achieve compliance with F686 Treatment and Services Necessary to Prevent and Heal Pressure Ulcers, schedule a mock survey with Polaris Group. We will help identify concerns and develop specific action steps to ensure your facility’s success.
