Table 1.

The criterion ‘pressure ulcers’ from the regulatory instrument for nursing home regulation in the Netherlands in 2009

IGZ standard: pressure ulcers	Aspects of risk	No risk	Slight risk	High risk	Very high risk
– Timely recognition of health risks.	– Timely recognition of health risks. – The right balance between adequate technical operation and the client's wishes and preferences/is representative at least of the prevention and treatment of pressure ulcers. – Aids readily available, and their appropriate and safe use. – Staff members apply guidelines and protocols based on current knowledge according to professional, generally accepted standards that include at least the subject of pressure ulcers. For each subject, national and, if possible, multidisciplinary guidelines are used. For the prevention and treatment of pressure ulcers, these guidelines are: – ‘Pressure ulcers’, second edition, CBO 2002: This guideline includes scientific results, views of professionals and best practices for pressure ulcers. – ‘Collaboration and logistics for pressure ulcers’, Salode 2003: Tripartite multidisciplinary guideline (NVVA, Arcares, Sting, AVVV, NPCP): This guideline includes practical applications for the prevention and treatment of pressure ulcers in nursing homes, and describes the actual tasks of the different officials.	– The protocol does not meet the requirements. – The presence of pressure ulcers is not recorded. – Redness of the skin that does not disappear when pressure is applied is not observed in a structural way. – Effective preventive measures are not usable. – Education or testing of knowledge and skills is missing. – Individual agreements about the prevention or treatment of pressure ulcers are not recorded in the client files. – The diagnostics, treatment and/or evaluation of pressure ulcers are not dealt with in a multidisciplinary fashion. – Conditions (like communication) that result in agreements not being kept.	– No aspects are checked. – Other arguments that indicate no risk.	– One aspect is checked. – Other arguments that indicate a slight risk.	– Preventive measures are not usable. – The protocol does not meet the requirements. – Two other aspects are checked. – Other arguments that indicate a high risk.	– Four or more aspects are checked. – Other arguments that indicate a very high risk.