title: Full-Thickness and Unstageable Pressure Injuries That Develop in Nursing Home Residents Despite Consistently Good Quality Care.
abstract: OBJECTIVE
  The purpose of this study was to determine whether stage 3, 4, and unstageable pressure injuries develop despite consistently good quality care (CGQC); ascertain whether these wounds occur without prior recognition of a lower-stage pressure injury; and to describe and analyze characteristics of nursing home residents and their higher-stage pressure injuries.
  
  
  METHODS
  Descriptive, nonexperimental, prospective analysis.
  
  
  METHODS
  A convenience sample of 20 residents from facilities participated in the study; research sites were located in 7 counties in Western Washington and Orange County, along with a single site in Wisconsin.
  
  
  METHODS
  CGQC facilities were identified using a 3-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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Stage 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 decision making around mandatory reporting, diagnosis, and prosecution.
authors.affiliation: Margaret W. Baker, PhD, RN, FAAN, FGSA, University of Washington School of Nursing, Seattle. JoAnne D. Whitney, PhD, RN, CWCN, FAAN, University of Washington School of Nursing, Seattle. Jeanne R. Lowe, PhD, RN, University of Washington School of Nursing, Seattle. Solomon Liao, MD, University of California-Irvine. David Zimmerman, PhD, University of Wisconsin-Madison. Laura Mosqueda, MD, Keck School of Medicine of the University of Southern California, Los Angeles.
authors.forename: Margaret W
authors.initials: MW
authors.lastname: Baker
authors.forename: JoAnne D
authors.initials: JD
authors.lastname: Whitney
authors.forename: Jeanne R
authors.initials: JR
authors.lastname: Lowe
authors.forename: Solomon
authors.initials: S
authors.lastname: Liao
authors.forename: David
authors.initials: D
authors.lastname: Zimmerman
authors.forename: Laura
authors.initials: L
authors.lastname: Mosqueda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003704:Dementia / Q000150:complications; D005242:Fecal Incontinence / Q000150:complications; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications; D008297:Male; D051346:Mobility Limitation; D003668:Pressure Ulcer / Q000145:classification* / Q000209:etiology / Q000451:nursing*; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D014549:Urinary Incontinence / Q000150:complications; D014861:Washington; D014922:Wisconsin