MDS Alert

This simple strategy can alert providers in both settings to patients at risk.

A number of nursing homes and hospitals nationwide are working together through Quality Improvement Organization initiatives to prevent pressure ulcers. As one example, Healthcare Quality Strategies (HQSI) in New Jersey has "had great success with pressure ulcer prevention," reports Bill Einreinhofer, spokesman for the QIO.

"The success has been due in part to structure where we divide the state into multiple small groups by regions we call clusters, which include nursing homes with referral hospitals," Einreinhofer says. The two provider types use the National Pressure Ulcer Advisory Panel staging definitions for describing pressure ulcers and share "gold standard" treatments, he adds.

Communication between the two providers is "critical" in preventing pressure ulcers, Einreinhofer says. Trust also plays an important role. In the past, the question about the origination of the pressure ulcer would come up -- "and on rare occasions, the blame game."

The QIO wanted to move beyond that quickly, which it did by using small group meetings and improved documentation, he reports.

Key: Finding ways to document and communicate a patient's pressure ulcer risks offers a win-win for patients and providers, Einreinhofer says. For example, one small group cluster in the initiative came up with a bright yellow alert sticker that the providers can use when they transfer patients. The transferring provider puts the sticker in a prominent place in the patientrelated information, prompting the receiving provider to look for more information, Einrinhofer explains. "The sticker in this case indicates pressure ulcer information but could be modified for other alerts such as fall risk," he adds.

"Another cluster chose instead to use a bright yellow piece of paper inside the transfer information to identify the risk factors and pressure ulcer information," Einreinhofer reports. The yellowcolored paper "is something you can't miss with all that white paper."