Implementing Best Practices in Pressure Ulcer Care: The Role of Continuous Quality Improvement

Abstract

Pressure ulcers are a common problem among nursing home residents that contribute significantly to the morbidity and mortality of care. Increasingly, evidence suggests that many of these pressure ulcers can be prevented, and the treatment of existing pressure ulcers improved, through the implementation of best practices. These best practices in the prevention and treatment of pressure ulcers have been identified and widely disseminated among clinicians practicing in nursing homes. Yet dissemination does not ensure adoption, particularly for something as complex as pressure ulcer care in nursing homes where successful methods for implementing best practices have not been consistently identified. The adoption of best practices and the corresponding reduction in pressure ulcer rates, though, is a priority that has been identified by diverse national organizations including the Department of Health and Human Services as part of its Healthy People 2010 initiative and the Strategic Framework Board for the National Quality Measurement and Reporting System. Industrial models of quality improvement, known as continuous quality improvement (CQI) or total quality management, are being advocated as an important mechanism for promoting the implementation of best practices in medical care. A number of studies have now specifically evaluated the impact of CQI on pressure ulcer care in nursing homes. However, whether CQI can lead to the implementation of best practices for pressure ulcers remains controversial. We now review this evidence and its implications for clinicians practicing in nursing homes.