Best Practices for Preventing Pressure Ulcers in Nursing Homes

Pressure ulcers, also known as bedsores, are a serious concern in nursing homes, affecting residents who are immobile, have compromised skin integrity, or suffer from chronic conditions. Prevention is not only essential for resident well-being but also for regulatory compliance and avoiding costly penalties. By implementing evidence-based best practices, nursing home staff can significantly reduce the occurrence of pressure ulcers and improve overall care quality.

Qsource, nursing home consultants dedicated to healthcare quality improvement, provides valuable guidance and resources to nursing homes in implementing best practices for pressure ulcer prevention. Their quality initiatives help facilities enhance patient outcomes and meet regulatory standards.

Learn about Our Consulting Services

Understanding the Risk of Pressure Ulcers

Pressure ulcers develop due to prolonged pressure on the skin, particularly over bony areas such as the heels, sacrum, and elbows. The primary risk factors include:

• Limited mobility – Residents who are bedridden or use wheelchairs.
• Poor nutrition and hydration – Inadequate intake of protein, vitamins, and fluids weakens skin integrity.
• Incontinence – Moisture and prolonged exposure to urine or feces can damage the skin.
• Medical conditions – Diabetes, vascular disease, and other conditions that reduce circulation and skin health.

Recognizing these risk factors early allows staff to implement preventive measures before ulcers develop.

Conduct Regular Skin and Risk Assessments

Early detection is crucial in preventing pressure ulcers. Nursing homes should implement:

• Comprehensive Skin Checks – Perform skin assessments on admission and routinely thereafter (e.g., daily or weekly depending on risk level).
• Using the Braden Scale – This evidence-based tool assesses a resident’s risk by evaluating sensory perception, moisture exposure, activity level, mobility, nutrition, and friction/shear risk.

Qsource provides training and tools to help nursing home staff improve their assessment techniques, ensuring that at-risk residents receive timely interventions.

Implement Repositioning and Offloading Strategies

Residents who remain in one position for too long are at the highest risk of developing pressure ulcers. To reduce risk:

• Follow a Repositioning Schedule – Turn and reposition residents at least every two hours while in bed and every hour if in a wheelchair.
• Use Support Surfaces – Pressure-relieving mattresses, cushions, and overlays can reduce pressure points.
• Encourage Mobility – Even small movements, such as adjusting sitting positions or performing range-of-motion exercises, can help prevent pressure buildup.

Qsource encourages nursing homes to integrate mobility programs and proper positioning techniques into daily care routines to enhance resident outcomes.

Maintain Proper Skin Care and Moisture Management

Keeping the skin clean, dry, and intact is key to preventing breakdown. Best practices include:

• Use Barrier Creams and Moisturizers – These protect against excessive moisture from incontinence and help maintain skin elasticity.
• Gentle Cleansing – Avoid harsh soaps and excessive scrubbing, which can weaken the skin.
• Address Incontinence Promptly – Use high-quality absorbent products and check for wetness frequently.

Qsource provides guidance on effective incontinence management programs that help facilities minimize skin breakdown and reduce pressure ulcer risk.

Ensure Proper Nutrition and Hydration

A well-balanced diet supports skin integrity and wound healing. Nursing homes should:

• Monitor Residents’ Nutritional Intake – Ensure they receive sufficient protein, vitamins (especially A, C, and E), and zinc.
• Provide Hydration Support – Encourage residents to drink fluids regularly and monitor for dehydration.
• Incorporate Dietitians into Care Teams – A registered dietitian can tailor nutritional plans for at-risk residents.

Qsource’s quality improvement programs emphasize the role of nutrition in pressure ulcer prevention, helping facilities adopt best practices in dietary management.

Train and Educate Staff on Pressure Ulcer Prevention

Continuous staff training ensures that all caregivers understand prevention strategies. Training should cover:

• Early identification of pressure ulcers
• Proper repositioning techniques
• Skin assessment protocols
• Documentation and regulatory compliance

Qsource supports nursing homes with educational resources and training programs that empower staff to provide high-quality wound prevention and care.

Engage Residents and Families in Prevention Efforts

Residents and their families play an important role in pressure ulcer prevention. Nursing homes should:

• Educate Residents on the Importance of Movement – Encourage even small movements to reduce pressure risks.
• Inform Families About Prevention Strategies – Teach families how to help reposition residents and recognize early warning signs.

Qsource offers materials and support for family engagement, ensuring that prevention efforts extend beyond staff interventions.

Implement a Quality Improvement Program

A structured quality improvement (QI) approach helps facilities monitor their progress and continuously refine their practices. Components of a successful QI program include:

• Regular Audits – Track pressure ulcer prevalence and evaluate compliance with preventive measures.
• Root Cause Analysis – Investigate new pressure ulcers to determine underlying causes and improve care processes.
• Collaboration with Healthcare Quality Experts – Partnering with organizations like Qsource ensures that nursing homes stay up to date with best practices and regulatory expectations.

Book a Free Consultation

Preventing pressure ulcers requires a proactive, team-based approach that integrates risk assessment, repositioning, skin care, nutrition, staff education, and quality improvement initiatives. By following these best practices and leveraging support from organizations like Qsource, nursing homes can significantly reduce the incidence of pressure ulcers, improve resident well-being, and ensure compliance with regulatory standards.