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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.

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.


Surgery may be required to repair stage 3 or 4 pressure injuries (based on the National Pressure Ulcer Advisory Panel Pressure Injury Staging System) and promote more rapid healing. When optimal management methods such as management of pressure and shear and local wound care have not been successful, surgical interventions are an important option. Consideration of these interventions should take into account the individual’s preferences, medical condition, nutritional status, ability to recover, and likelihood of improvement in quality of life.

For Patients

If you have a stage 3 or 4 pressure injury that is not healing with optimal care, you should be referred for a surgical consultation to discuss whether or not you are eligible for surgery.


For Clinicians

Refer people who are adherent to treatment but have a stage 3 or 4 healable pressure injury that is not responding to optimal care for a surgical consultation to determine their eligibility for surgical intervention.


For Health Services

Ensure that systems, procedures, and resources are in place to refer people who are adherent to treatment with a stage 3 or 4 healable pressure injury that is not responding to optimal care for a surgical consultation to determine their eligibility for surgical intervention.

Process Indicators

Percentage of people with a stage 3 or 4 pressure injury that is not responding to optimal care who are referred for a surgical consultation

  • Denominator: number of people with a stage 3 or 4 pressure injury that is not responding to optimal care

  • Numerator: number of people in the denominator who are referred for a surgical consultation

  • Data source: local data collection


Median time from referral to first surgical consultation for people with a stage 3 or 4 pressure injury that is not responding to optimal care

  • Data source: local data collection


Median time from surgical consultation to date of surgery for people with a stage 3 or 4 pressure injury that is not responding to optimal care

  • Data source: local data collection

Optimal care

This includes management of pressure and shear and local wound care. Operative repair may be required, including flap reconstruction, direct wound closure, or skin grafting if it is in alignment with the individual’s condition and goals of care.

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