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Full-Thickness and Unstageable Pressure Injuries That Develop in Nursing Home Residents Despite Consistently Good Quality Care

NCJ Number
Journal of Wound Ostomy and Continence Nursing Volume: 43 Issue: 5 Dated: September/October 2016 Pages: 464-470
M. W. Baker; J. D. Whitney; J. R. Lowe; S. Liao; D. Zimmerman; L. Mosqueda
Date Published
September 2016
7 pages

This study examined whether stages 3, 4, and unstageable pressure injuries develop despite consistently good quality care (CGQC), assessed whether these wounds occur without prior recognition of a lower-stage pressure injury, and described and analyzed characteristics of nursing home residents and their higher-stage pressure injuries.


CGQC facilities were identified using a three-step incremental approach. Research assistants verified CGQC at the facility level. After data collection was complete, a Longitudinal, Expert, All-Data Panel reviewed cases for a final resident-level validity check for CGQC. Remaining cases were submitted to analysis. The study found that residents who developed advanced stage pressure injuries despite CGQC were older, had limited mobility, dementia, comorbid conditions, urinary or fecal incontinence, and infections. The pressure injuries were relatively small and had little-to-no undermining, exudate, or edema. Stages 3, 4, and unstageable pressure injuries were observed in nursing home residents despite CGQC. Results from this study may serve as a baseline for further research to evaluate characteristics of these wounds when they develop under settings of poor-quality care. Findings also may be useful in creating evidence-based practice guidelines to support decisionmaking in mandatory reporting, diagnosis, and prosecution. (Publisher abstract modified)