Skin Integrity

Skin integrity refers to intact skin across the entire body. As the largest organ in the body, skin performs it many functions best when it is healthy and unbroken. Damaged skin occurs in many forms, including pressure ulcers, tears, burns and medical-surgical intervention.  Many consider maintaining skin integrity, a primary role of nursing care.


Broken skin impairs function. Pressure ulcers are the predominate skin integrity issue included in measures of quality. Pressure ulcers are associated with shorter life expectancy, increased pain, reduced function, increased use of facility care and increased costs.


The IMPACT act includes reporting on the number of patients with new or worsening pressure ulcers. 


Home health agencies will collect and report this information as of January 1, 2017, via the OASIS tool. 


  • Ensure all RNs and new staff understands and utilize the OASIS C2
  • Establish a pressure ulcer risk reduction protocol
  • Establish a mechanism to monitor pressure ulcer rates and improvements over time
  • Evaluate clinical expertise for managing skin integrity and consider opportunities to include Wound, Ostomy, and Continence Nurses (WOCN) certified nurses in care 


Failure to report measures will result in a 2% reduction in market basket in 2018. Ultimately these quality measures will be used to inform the payment policy for all types of PAC.


ElevatingHOME-Developed Resources
VNAA Blueprint for Excellence, IMPACT Act Resources
Webinar Archive: The Effects of Hypochlorus Acid as an Adjunct to Treatment of Chronic Wounds
Webinar Archive: Cost-Saving Wound Care for the Home Care Patient
Public Resources
Overview of IMPACT Act (CMS)
Slides from CMS Webinar: Quality Measures and the IMPACT Act (MLN)
Recording of CMS Webinar: Quality Measures and the IMPACT Act (MLN)
Partner Resources
Education and Evidence (Smith & Nephew)
Global Wound Academy (Smith & Nephew)
Extending the TIME Concept (Smith & Nephew)
Pressure Injury Classification: Terminology and Staging (Smith & Nephew)
Braden Scale Overview Video (Smith & Nephew)
Debridement: Clinician’s Resource Guide (Smith & Nephew)
Accredited Education Offerings (Smith & Nephew)
Other Resources (may involve a fee to access)

Other Topics



Direct Care