Take the pressure out of pressure ulcers

Kristen Thurman, PT, CWS

Susan R. Wickard, RN, BSN, CWCN, CWS, CLNC

Pressure ulcers continue to cause pain and suffering to patients and families as well as increase costs to the healthcare system. Approximately 600,000 patients die from complications related to pressure ulcers each year.

1 At least one pressure ulcer develops in more than 20 percent of long-term care residents who have lived in LTC facilities for at least two years.

2 Treating pressure ulcers can cost facilities anywhere from $2,400 to $12,000 per month and F-tag 314 fines can cost facilities up to $10,000 per day per ulcer.

3 Lawsuit awards to residents and families of those who developed pressure ulcers in a facility’s care averaged $3.5 million

4 per lawsuit and went as high as $312 million.


Due to the effects on quality of life and strain on the healthcare system associated with pressure ulcers, many national organizations are working together to prevent and heal pressure ulcers quickly. The National Pressure Ulcer Advisory Panel (NPUAP) and Wound Ostomy Continence Nurses Society (WOCN) are two such organizations that offer guidelines for the prevention and treatment of pressure ulcers. The American Association for Long Term Care Nursing (AALTCN) states that education for the nursing caregivers is extremely important to prevent and treat costly pressure sores.6 The AALTCN participates in the NPUAP as a member of the Collaborating Organization Council in an effort to keep its members up to date on new practices and technology.


According to the NPUAP Repositioning for the Prevention of Pressure Ulcers Guidelines, individuals should be repositioned in a way that pressure is relieved or redistributed to reduce the amount of pressure an individual is exposed to.7 This has been a challenge to caregivers. Now, a bedside tool is available to give them visual confirmation of where areas of high pressure exist under their residents. Pressure is the main causative agent in the development of a pressure ulcer. Off-loading pressure decreases the possibility of a resident developing a pressure ulcer. The challenge is for caregivers to be able to accurately distribute the pressure under residents to eliminate high-pressure areas that could cause tissue damage.

Pressure mapping technology helps to identify where high interface pressures exist between the patient and mattress surface. A laboratory pressure mapping system was developed by Purdue University and has assisted bed companies in developing better mattresses for more than 10 years. That system is used for a short time to create a pressure map of a patient on a certain surface in order to evaluate its effectiveness.

Another new technology now offers bedside pressure mapping that displays a real-time color image of pressure data that can be used on any existing bed, allowing caregivers and patients to see and react to the real-time color display. The real-time feedback is an invaluable tool for guiding caregivers in off-loading high pressure points, especially over bony prominences.


The NPUAP guidelines also state that the appropriateness and functionality of a support surface should be examined on every encounter with an individual.7 To do this, caregivers use a bedside pressure mapping system’s display to ensure residents are on an appropriate surface and are not “bottoming out.” Caregivers have also found this tool useful in identifying ineffective support surfaces or powered beds that are malfunctioning or have inadvertently been powered off while the resident was on the bed. In these cases, a bedside pressure mapping system was essential in identifying these potentially harmful issues and helped caregivers resolve them quickly.

The current NPUAP and WOCN guidelines reflect a turning schedule of every two hours, or more often if residents are at high risk for developing pressure ulcers.7 It can be a difficult, time-consuming task for caregivers to track to ensure every patient is turned on schedule. Many facilities have implemented reminder tools for caregivers to turn patients every two hours. A few examples include pagers that alert caregivers and a song or sound that plays on the overhead system.

Repositioning multiple patients at the same time can be challenging to caregivers. With a bedside pressure mapping system, caregivers can select from a variety of turning schedules and the system will track the time until the next repositioning is due. Once the time has expired, an alert notifies caregivers that a repositioning is due. The nurse call system can also be connected to the bedside pressure mapping system and the repositioning alert will signal through the existing nurse call system to provide individualized turning schedules.

Since Medicare reduced overall SNF payments by 11.1 percent on October 1, facilities need to decrease costs without compromising residents’ quality of care. As payments continue to be reduced and facility operating budgets shrink, taking the pressure out of pressure ulcers could be a pathway to decreasing the enormous cost of pressure ulcers and assist in preserving quality of care to residents.

Kristen Thurman, PT, CWS, is the Director of Clinical Services for Wellsense, USA. She can be reached at


Susan R. Wickard, RN, BSN, CWCN, CWS, CLNC, is the Clinical Consultant and Collaborating Organization Council Representative to the National Pressure Ulcer Advisory Panel for the AALTCN. She can be reached at



  1. Strategies for Preventing Pressure Ulcers, Joint Commission Perspectives on Patient Safety, Volume 8, Number 1, January 2008, pp. 5-7(3). Available at: www.jcrinc.com/Pressure-Ulcers-stage-IIIIV- decubitis-ulcersd.
  2. Voss AC, Bender SA, Ferguson ML, et al. Long-term care liability for pressure ulcers. Journal of the American Geriatric Society 2005; 9:1587-92.
  3. Lyder C. A Comprehensive Program to Prevent Pressure Ulcers in LTC exploring Costs and Outcomes. Available at: www.o-wm.com/article/350.
  4. Dorner B, Posthauer ME, Thomas D. The Role of Nutrition in Pressure Ulcer Prevention and Treatment: National Pressure Ulcer Advisory Panel White Paper.Available at: www.npuap.org/Nutrition White Paper Website Version.pdf
  5. Voss, et al. Long Term Care Liability for Pressure Ulcers. Journal of the American Geriatric Society 2005; 9:1587-92.
  6. AALTCN Quick Fact Sheet Pressure Ulcers. https://ltcnursing.org/Culture-of-Safety-Learning-Community.
  7. NPUAP and EPUAP. Pressure Ulcer Prevention: Quick Reference Guide 2009. Available at: www.npuap.org/Final_Quick_Prevention_for_web_2010.pdf.

Long-Term Living 2011 October;60(10):22-23

Topics: Articles , Clinical