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Transitional Care and Pressure Ulcers Project Toolkit

In 2007, the Oregon IHI Network and the Oregon leadership of the Advancing Excellence in America's Nursing Homes campaign formed a Joint Committee to plan and develop cross-setting interventions for transitional care, with an initial focus on pressure ulcers. The Joint Committee convened an Advisory Panel of clinicians, educators, health plan representatives, and experts from regulatory and quality improvement agencies to:

  • Identify best practices for preventing or minimizing pressure ulcers in hospitals, nursing homes, community-based long-term care, and home health agencies, and
  • Develop a handoff data set of pressure ulcer-related information that would accompany patients in transition from one setting to another

These tools, with support materials such as the Braden Scale for predicting pressure ulcer risk, were compiled in a toolkit and then pilot-tested in multiple care settings in four communities. The Joint Committee and its constituent organizations, including Seniors and People with Disabilities, have endorsed the toolkit materials as support for efforts to improve pressure ulcer prevention and care in Oregon.

Please refer to the following link for the Transitional Care & Pressure Ulcers Project Toolkit:

For questions or suggestions, please contact:

Stacy Moritz
Director, Medicare Quality Services, Acumentra Health