Ask the treatment expert: What is tissue tolerance?

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Ask the treatment expert
What is tissue tolerance?

The State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities defines tissue tolerance as “the ability of the skin and its supporting structures to endure the effects of pressure, without adverse effects”. In other words, the length of time a resident can maintain a position without skin damage.

To inspect the skin for tolerance:

1) Position the resident in a chair or bed (note position) for a one-hour interval.  After an hour, reposition the resident off the area exposed to pressure and observe/document any areas of redness. Recheck the area after 30 to 45 minutes.

• If redness has persisted, stop the test. The resident requires repositioning at a more frequent interval.

• If there is no redness, proceed to step No. 2.

2) Position the resident in chair or bed (same location as used in No. 1) for a 1½- hour interval. After the 1½ -hour interval, reposition and observe/document any areas of redness. Recheck the area after 30 to 45 minutes.

• If redness has persisted, stop the test! The resident requires repositioning at an interval of no more than every hour.

• If there is no redness, proceed to step No. 3.

3) Position the resident in chair or bed (same location as used in steps No. 1 and No. 2) for a two-hour interval. After the two-hour interval, reposition the resident and observe/document any areas of redness. Recheck the area after 30 to 45 minutes.  

•If redness has persisted, the resident requires repositioning at an interval of no more than every 1½ hours.

• If there is no persistent redness, the test is complete and the resident requires repositioning at an interval of every two hours.