A diligent and sustained focus on preventing serious bed sores in nursing home residents was remarkably effective according to the results of a project sponsored by the Centers for Medicare & Medicaid Services.

Results of the project have just been published in the Journal of the American Geriatrics Society.

"Reducing pressure ulcers-the clinical term for bed sores-is a priority for CMS and quality improvement organizations (QIOs) nationwide," said Kerry Weems, acting administrator of CMS. "It is also one of the most important goals of the voluntary Advancing Excellence in America's Nursing Homes campaign, of which CMS is a founding member.

The nationwide project stopped more than two-thirds of the residents' serious bed sores - a dreaded complication of frailty and disability in old age - in the thirty-five nursing homes that reported data from the project, the paper reports.

"This project showed clinicians and managers that major improvement is possible, even for conditions affecting our most frail beneficiaries," added Barry M. Straube, MD, CMS chief medical officer and director of the Office of Clinical Standards and Quality. "The results will enable us to separate the serious pressure ulcers from the superficial ones, a change that will help beneficiaries and their families to see whether a nursing home has implemented the best practices available."

The publication reflects findings that stem from a collaboration among 52 nursing homes in 39 states, working voluntarily with experts on process improvement and preventing pressure ulcers. Participating facilities found that the onset of new serious bed sores (the ones that go through the skin and often to the bone) declined 69 percent.

"This is a remarkable gain in a large number of facilities, against a condition that is as devastating and costly as it has been resistant to improvement," said Weems. "In this case, the work of Medicare's Quality Improvement Organizations (QIOs) has helped us refocus our research and change our data collection and public reporting so that CMS can do a better job informing residents, family members, and the nursing homes themselves about nursing home quality.

Because serious bed sores often develop before a patient enters a nursing home, the project's teams often encouraged hospitals, home health agencies, and emergency services to collaborate to identify and reduce causes of bed sores. The project also found that direct care providers-often certified nursing assistants-could be effective leaders of quality improvement efforts.

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