Underreporting Pressure Sore Injuries – A National Problem

Nursing homes that receive federal funding are required to report their incidence of pressure wounds.  Medicare has also financially penalized hospitals who allow patients to develop pressure wounds on their watch.

A recent study found pressure ulcers (also known as bedsores or decubitus ulcers) were substantially underreported in Nursing Home Compare (NHC), a website created in 1998 by CMS to publicly report patient safety and quality of care for every nursing home in the country. Nursing homes compete for high scores on this website, which is used by many Americans to select a nursing home.


Furthermore, the researchers discovered that about 30% of bedsores suffered by short-term nursing home residents and around 40% of bedsores in long-term residents were not reported at all to the database.  “This is no surprise” explains nursing home attorney Jeffrey J. Downey. “I often see that facilities attempt to characterize pressure wounds as other forms of skin breakdown, like blisters or rashes.”


Pressure wounds are supposed to be assessed based on their stages, one through four.  Stage one is a simple red area and stage four is a wound that has gone deep into the fatty tissue up to the bone.  Many facilities also under-stage their wounds in an attempt to limit their liability for such avoidable injuries.


“These findings are important because they indicate that the publicly reported numbers are inaccurate and cannot be used as a basis for judging the nursing home quality of care,” said Prachi Sanghavi, PhD, senior researcher and an assistant professor of public health sciences at the University of Chicago.   Based on roughly 400,000 hospital admissions and 60,000 linked admissions to nursing homes, the researchers found the following:

  • 75% of primary pressure wounds were reported and 70% were reported within one stage of the hospital diagnosis
  • 52% of secondary pressure ulcers were reported and 46% were reported within one stage of the hospital diagnosis
  • Primary ulcers were considered more severe than secondary ulcers and “reporting substantially increased with higher stages.”
  • 22% of primary pressure ulcers were not reported by the nursing homes to CMS. That percentage doubled to 45% for secondary pressure ulcers.

The potential underreporting of pressure wounds raises a significant concern, said Amanda Lathia, MD, assistant professor at the Case Western University School of Medicine.  “If CMS is not able to reliably measure adverse events in facilities, such as falls and wounds, it will make it difficult for CMS to identify and address factors contributing to these events, such as insufficient nursing home staff members,” she said.  Underreporting also questions the accuracy of facility star ratings, she added, which are used by patients and families when selecting nursing facilities for both long-term care and post-acute rehab care.


“Lack of proper reporting also involves improper or false documentation of the severity of the wound to avoid legal liability,” explains Downey.  Its not uncommon to see stage IV wounds get characterized as stage II upon discharge, or the facility may classify the pressure wound as some other form of skin breakdown.


“Despite this being a known problem in the industry, nothing has been done to address it explains”  Downey.  Since the high incidence of pressure wounds can indicate a troubled facility, this study suggests that nursing facilities are underreporting sentinel events.  A sentinel event is a patient safety event that results in death, permanent harm or severe temporary harm. Common sentinel events include falls, treatment delays, leaving foreign objects in the body during surgery, assault, fire, medication errors and patient self-harm.


If you have questions about pressure wounds or the development of pressure wounds at a nursing facility or hospital, call the Law Office of Jeffrey Downey for help.

If you have questions about pressure wounds or the development of pressure wounds at a nursing facility or hospital, call the Law Office of Jeffrey Downey for help.


Contact Information:

The Law Office of Jeffrey J. Downey, P.C.

McLean Virginia Office

8270 Greensboro Drive, Suite 810

McLean, VA 22102

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Phone: 703-564-7318

Fax: 703-883-0108

Website: https://www.jeffdowney.com/

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