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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.

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.


Wound care that maintains moisture balance to promote healing includes cleansing of the wound (tap water is usually sufficient) and selection of a dressing that promotes a moist wound healing environment (for healable ulcers) or moisture reduction (for maintenance ulcers and non-healable ulcers). Cleansing the wound promotes healing by supporting improved wound assessment, increased comfort when adherent dressings are removed, and the potential for rehydration of the wound. There are many options for wound dressings. Selection of these products should be based on patient preference; pain and tolerance; clinical assessment of the wound, including position, size, and depth; frequency of dressing change; and ability to maintain a moist wound bed, control exudate, and avoid skin breakdown of the surrounding skin.

For Patients

Your health care team will determine whether your wound can heal or not. You should have a dressing that keeps the wound moist if it can heal, or dry if it cannot heal.


For Clinicians

For people with a pressure injury, provide wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed. A moist wound environment is appropriate for healable pressure injuries. Moisture reduction is appropriate for maintenance and non-healable pressure injuries.


For Health Services

Ensure that systems, procedures (protocols), and resources are in place to support clinicians in providing wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.

Process Indicators

Percentage of people with a healable pressure injury who receive wound care that maintains the appropriate moisture balance in the wound bed and a moist wound environment

  • Denominator: number of people with a healable pressure injury

  • Numerator: number of people in the denominator who receive wound care that maintains the appropriate moisture balance in the wound bed and a moist wound environment

  • Data source: local data collection


Percentage of people with a maintenance or non-healable pressure injury who receive wound care that maintains the appropriate moisture reduction in the wound bed

  • Denominator: number of people with a maintenance or non-healable pressure injury

  • Numerator: number of people in the denominator who receive wound care that maintains the appropriate moisture reduction in the wound bed

  • Data source: local data collection

Moisture management

This is specific to the type of wound:

  • Moisture balance and a moist wound environment for healable pressure injuries (pressure injuries that have adequate blood supply and can be healed if the underlying cause is addressed and treated). Note: increased moisture is a sign of infection, which should be treated

  • Moisture reduction for maintenance pressure injuries (pressure injuries that have healing potential, but barriers are present that may prevent healing such as lack of access to appropriate treatment and poor adherence to treatment) or non-healable pressure injuries (pressure injuries that are not likely to heal because of nontreatable causes or illnesses)

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