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Evidence to Improve Care

Pressure Injuries

Care for Patients in All Settings

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence. ​

See below for the quality statements and click for more detail.​


Quality Statement 1: Risk and Skin Assessment
People with at least one risk factor for developing a pressure injury undergo a comprehensive risk assessment, including a skin assessment, to determine their level of risk. Those at risk are reassessed on an ongoing basis.


Quality Statement 2: Patient Education and Self-Management
People who have developed or are at risk of developing a pressure injury and their families and caregivers are offered education about pressure injuries, including an overview of the condition; the importance of mobilization and repositioning for pressure redistribution; and who to contact in the event of a concerning change.


Quality Statement 3: Comprehensive Assessment
People with a pressure injury undergo a comprehensive assessment, including an evaluation of risk factors that affect healing to determine the healing potential of the wound.


Quality Statement 4: Individualized Care Plan
People who have developed or are at risk of developing a pressure injury have a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


Quality Statement 5: Support Surfaces
People who have developed or are at risk of developing a pressure injury are provided with appropriate support surfaces based on their assessment.


Quality Statement 6: Repositioning
People who have developed or are at risk of developing a pressure injury receive interventions that enable repositioning at regular intervals, encouraging people to reposition themselves if they are mobile or helping them to do so if they cannot reposition themselves.


Quality Statement 7: Wound Debridement
People with a pressure injury have their wound debrided if it is determined as necessary in their assessment, and if it is not contraindicated. Debridement is carried out by a trained health care professional using an appropriate method.


Quality Statement 8: Local Infection Management
People with a pressure injury and a local infection receive appropriate treatment, including antimicrobial and non-antimicrobial interventions.


Quality Statement 9: Deep/Surrounding Tissue Infection or Systemic Infection Management
People with a pressure injury and suspected deep/surrounding tissue infection or systemic infection receive urgent assessment (within 24 hours of initiation of care) and systemic antimicrobial treatment.


Quality Statement 10: Wound Moisture Management
People with a pressure injury receive wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.


Quality Statement 11: Surgical Consultation
People who are adherent to treatment and have a stage 3 or 4 healable pressure injury that is not responding to optimal care are referred for a surgical consultation to determine their eligibility for surgical intervention.


Quality Statement 12: Health Care Provider Training and Education
People who have developed or are at risk of developing a pressure injury receive care from health care providers with training and education on the assessment and treatment of pressure injuries.


Quality Statement 13: Transitions in Care
People with a pressure injury who transition between care settings have a team or provider who is accountable for coordination and communication to ensure the effective transfer of information related to their care.

1

Risk and Skin Assessment

People with at least one risk factor for developing a pressure injury undergo a comprehensive risk assessment, including a skin assessment, to determine their level of risk. Those at risk are reassessed on an ongoing basis.


An assessment to determine an individual’s level of risk of developing a pressure injury can inform appropriate prevention strategies. People are considered to be at high risk if they have multiple risk factors, a history of pressure injuries, and/or an active pressure injury.

For Patients

If you are immobile or cannot be moved around, you may be at risk of developing a pressure injury. You should have a full risk assessment that includes a skin assessment. This information will be used to determine how often you should be re-checked.


For Clinicians

Carry out a comprehensive risk assessment, including a skin assessment, of all people with at least one risk factor for developing a pressure injury, to determine their level of risk. Reassess those at risk on an ongoing basis.


For Health Services

Ensure that health care professionals have access to comprehensive risk-assessment tools, including tools and protocols for skin assessment.

Process Indicators

Percentage of people with at least one risk factor for developing a pressure injury who have a comprehensive risk assessment, including a full skin assessment, upon admission to acute or long-term care or their first home care visit

  • Denominator: number of people with at least one risk factor for developing a pressure injury

  • Numerator: number of people in the denominator who have a comprehensive risk assessment, including a full skin assessment, upon admission to acute or long-term care or their first home care visit

  • Data source: local data collection


Percentage of people at high risk for developing a pressure injury who are reassessed on an ongoing basis or when there is a significant change in their condition or risk factors

  • Denominator: number of people at high risk for developing a pressure injury

  • Numerator: number of people in the denominator who are reassessed on an ongoing basis (frequency may vary and is based on an individual’s level of mobility, acuity of illness, and setting of care) or when there is a significant change in their condition or risk factors

  • Data source: local data collection

Risk factors

These include:

  • Admission to a health care facility (such as acute care, complex continuing care, rehabilitation, or long-term care)

  • Impaired or limited mobility

  • Use of an assistive device such as a wheelchair

  • Use of medical devices, such as tubes

  • Inability to reposition oneself

  • Limited ability or inability to feel pain or pressure

  • Nutritional deficiency

  • Being underweight

  • Cognitive impairment

  • Past or current pressure injuries


Comprehensive risk assessment

This includes:

  • An assessment of the following:
    • Mobility and ability to reposition oneself

    • Positioning throughout the day

    • Support and transfer surfaces, and areas of pressure

    • Impaired sensation or numbness

    • Infection

    • Risk of malnutrition

    • Cognitive ability

    • Continence

    • Nerve injuries that can cause spasticity, increased tone, and shear forces

    • Factors that affect healing (poor circulation, loss of sensation, systemic infection)

Examples of validated risk-assessment tools to support clinical judgement are the interRAI Pressure Ulcer Risk Score (PURS), the Braden scale, the Braden Q scale (pediatric population), the Waterlow score, or the Norton risk assessment scale.


Skin assessment

This includes a full head-to-toe assessment of the following:

  • Skin integrity, focusing on high-pressure areas (skin covering bony prominences)

  • Skin discolouration (including redness)

  • Blanching, swelling, pain, or induration (hardening)

  • Changes in skin moisture and temperature


Reassessed on an ongoing basis

The frequency of the reassessment varies and is based on a person’s level of mobility, acuity of illness, and setting of care. For example, individuals who are immobile, confined to a bed or wheelchair, or are critically ill may need to be reassessed daily.

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