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Evidence to Improve Care

Summary

This quality standard focuses on care for people who have developed or are at risk of developing a pressure injury. The scope of the standard covers all settings, including primary care, home and community care, long-term care, and acute care. It also provides guidance on optimal care when a person transitions between these settings—for example, when someone is discharged from a hospital to their home or a long-term care home.


This quality standard focuses on care for people who have developed or are at risk of developing a pressure injury. The scope of the standard covers all settings, including primary care, home and community care, long-term care, and acute care. It also provides guidance on optimal care when a person transitions between these settings—for example, when someone is discharged from a hospital to their home or a long-term care home. It is one of three quality standards related to wound care; the other two are for diabetic foot ulcers and venous leg ulcers.

Wounds represent a significant burden for patients, their caregivers and families, clinicians, and the Ontario health system, but the human and financial costs of wounds are not fully appreciated. People with pressure injuries report low levels of health-related quality of life, high rates of depression, and high rates of pain and discomfort. Pressure injuries are characterized as "damage to the skin and/or underlying soft tissue, usually over a bony prominence or related to a medical or other device." They "occur as a result of intense and/or prolonged pressure and/or shear." Pressure injuries can present as intact skin or as an open ulcer. Pressure injuries are more likely to occur in people who are older; reside in long-term or critical care settings; are acutely or seriously ill; have experienced trauma; or have a spinal cord injury, a fractured hip, a neurological condition, diabetes, impaired mobility, or nutritional deficiency. Most pressure injuries are treatable if they are detected early, but when they are left untreated, they are associated with adverse outcomes for the people who have them and high treatment costs for the health system.

Wound care represents a significant area of opportunity for quality improvement in Ontario. There are important gaps and variations in access to services and in the quality of care received by people who have developed or are at risk of developing a pressure injury. For example, rates of new pressure injuries in home care varied two-fold across community care access centres in 2013/2014 (Home Care Database, 2014). Previous efforts to improve the coordination and delivery of wound care across the province have highlighted the inconsistent application of best practice guidelines, a lack of standardized documentation, tracking of wound outcome measures, and poor coordination of care.

Based on the best available evidence and guided by expert consensus from health care professionals and people with lived experience, this quality standard addresses key areas with significant potential for quality improvement in the care of people who have developed or are at risk of developing a pressure injury in Ontario. The 13 quality statements that make up this standard provide guidance on high-quality care, with accompanying indicators to help health care professionals and organizations measure their own quality of care. Each statement also includes details on how it affects people who have developed or are at risk of developing a pressure injury, their caregivers, health care professionals, and health care services at large.

Note: In this quality standard, the term patient includes community care clients and residents of long-term care homes.

This quality standard is underpinned by the principles of respect and equity.

People who have developed or are at risk of developing a pressure injury should receive services that are respectful of their rights and dignity and that promote self-determination.

A high-quality health system is one that provides good access, experience, and outcomes for all Ontarians, no matter where they live, what they have, or who they are.

People who have developed or are at risk of developing a pressure injury are provided services that are respectful of their gender, sexual orientation, socioeconomic status, housing, age, background (including self-identified cultural, ethnic, and religious background), and disability.

We have set a limited number of objectives for this quality standard as a whole, and we have mapped these objectives to indicators to measure its success. In addition, each quality statement within this quality standard is accompanied by one or more indicators to measure the successful implementation of the statement.

  • Percentage of patients with a new pressure injury in a 6-month period (incidence)

  • Percentage of patients with a pressure injury in a 6-month period (prevalence)

  • Percentage of patients with a closed pressure injury in a 12-week period

  • Percentage of patients with a healed pressure injury who were diagnosed with a secondary pressure injury within 1 year (recurrence)

  • Percentage of patients with a pressure injury who had a diagnosed wound infection in a 6-month period

  • Percentage of patients with a pressure injury in a 12-month period who reported high satisfaction with the care provided

The work on this quality standard started in November 2017.

For more information, contact QualityStandards@HQOntario.ca.

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