The Need for Better Understanding and Documentation of Pressure Ulcers in Los Angeles Skilled Nursing Facilities

The Journal of the American Medical Directors Association (JAMDA) recently published an article titled, “Factors Associated with Physician and Nurse Practitioner Pressure Ulcer Staging Practices in Rehabilitative and Long-Term Care” that studied patterns of assessment, staging, and documentation practices concerning pressure ulcer wounds in skilled nursing facilities.

The study investigated patients within two different facilities: a chronic hospital and a nursing home facility that each provided 140 beds, 100 of which were long term care and 40 of which were rehabilitative. They examined data provided by two different sources: a provider and a nurse from the chronic hospital and the nursing home. Both facilities established weekly wound rounds and created a wound log in order to keep track of patients with developing pressure ulcers. Of the 57 subjects involved with the study, the health care provider only documented pressure ulcer stages for 30. In comparison, the nurse was able to document a pressure ulcer stage for 52 of the 57 subjects.

Researchers found that there is noticeable confusion in the determination of pressure ulcer stages between providers and nurses, and that there is a lack of a standardized means to clearly categorize the stage of a pressure ulcer. These inconsistencies in the staging of pressure ulcers can be fatal, as applying improper treatments could result in further injury or death of the patient. For example, if an uneducated nurse treated a Stage 3 pressure ulcer as a Stage 1, the treatment would be nowhere near effective enough to heal the wound, and could lead to the patient’s death. Therefore, it is very important that the medical providers and nurses are able to accurately assess the stage of pressure ulcers.

However, even when the staging of a patient’s pressure ulcer is consistent among different staff members of the nursing home, the study notes that “documentation practices are of particular importance as discrepancies between nursing documentation…may compromise patient care.” For instance, if one nurse fails to document that a patient is beginning to develop a pressure ulcer, the nurse working the next shift may be unaware of this new condition and fail to provide the patient with the proper care. Consequently, the pressure ulcer will be allowed to become more severe. Ultimately, the nursing home staff is responsible for maintaining organized records of their patients’ health.

It becomes apparent that a nursing home’s staff plays an instrumental role in the treatment and prevention of pressure ulcers. Unfortunately, however, pressure ulcers are often caused by a facilities’ lack of staff or education. You should also be cautious of the quality of your loved one’s nursing staff. Even if it appears that the facility is fully staffed, many nursing homes often cut costs by hiring less licensed nurses and more nursing assistants, thus sacrificing the qualifications needed to properly care for patients. Studies have actually linked lower levels of direct care from Registered Nurses to increased incidents of pressure ulcers.

The providers and nurses within JAMDA’s study display an alarming lack of knowledge concerning pressure ulcers. Providers and nurses alike should be able to understand the importance of clearly documenting pressure ulcers. Either ignoring or incorrectly assessing the stage of a pressure ulcer violates the Patients’ Bill of Rights, which states that skilled nursing facilities are obligated to ensure that patients are free from developing pressure sores. Moreover, if the patient does develop a pressure sore, the patient has a right to receive the appropriate treatments and care.

It is much easier to prevent a pressure ulcer from forming in the first place, as treating an already developed pressure ulcer can be problematic. There are many preventative measures that can be taken, ranging from movement and position changes to a nutritious, well balanced diet. However, for these preventative measures to be effectively carried out, one of the most important factors in preventing pressure ulcers is that an adequate nursing staff level should be provided by the health facility to their patients.


If you believe there is a possibility that your loved one has been improperly taken care of due to a lack of staff or education, or that they are currently at risk for injury within a facility, please contact us today. Here at the Law Offices of Ben Yeroushalmi, we specialize in nursing home neglect litigation and therefore have extensive experience handling cases concerning pressure ulcers. We are determined to protect a patient’s right to a safe and adequately staffed environment within their nursing home.