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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.

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.


A comprehensive assessment helps identify causative and contributing factors, supports accurate diagnosis, and informs the treatment and management of pressure injuries. The results of the assessment help to determine the healing potential of the injury (wounds may be categorized as healable, maintenance, or non-healable) and inform a corresponding approach to optimal wound care and management. Healable wounds have adequate blood supply and can be healed if the underlying cause is addressed and treated. Maintenance wounds have healing potential, but barriers are present that may prevent healing (such as lack of access to appropriate treatments or poor adherence to treatment). Non-healable wounds are not likely to heal because of non-treatable causes or illnesses. Comprehensive assessment also provides an opportunity to determine factors that may affect wound healing and risk factors for recurrence. Depending on the care setting, the components of the assessment may be carried out by multiple members of an interprofessional team.

For Patients

If you have a pressure injury, you should have a full assessment that includes a skin assessment. Your health care team will want to learn more about your health history, concerns, and preferences. They should also examine your skin from head to toe. They will use this information to develop a care plan with you.


For Clinicians

Carry out a comprehensive assessment for people with a pressure injury to determine the healing potential of the wound. The results should inform their individualized care plan.


For Health Services

Ensure that tools, systems, processes, and resources are in place to help clinicians assess people with a pressure injury. This includes providing the time required for a full assessment and ensuring access to assessment tools.

Process Indicators

Percentage of people with a pressure injury who have a comprehensive assessment at first presentation that informs their individualized care plan

  • Denominator: number of people with a pressure injury

  • Numerator: number of people in the denominator who have a comprehensive assessment at first presentation that informs their individualized care plan

  • Data source: local data collection


Percentage of people with a pressure injury who have a comprehensive assessment at each transition that informs their individualized care plan

  • Denominator: number of people with a pressure injury

  • Numerator: number of people in the denominator who have a comprehensive assessment at each transition that informs their individualized care plan

  • Data source: local data collection

Comprehensive assessment

This includes the following components, at a minimum:

  • A comprehensive physical examination and health history, including history of pressure injuries, past medical history, allergies, medications, family history, and psychosocial history

  • An assessment of risk factors, including:

    • Mobility, ability to reposition oneself, positioning throughout the day, and presence of impaired sensation, neuropathy, or numbness

    • Areas of pressure and the need for pressure redistribution devices

    • Presence of infection

    • Nutrition assessment using a validated tool

    • Cognitive assessment

    • Continence assessment

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

    • Factors that may affect wound healing (nutritional deficiency, poor circulation, loss of sensation, systemic infection)

  • A full (head-to-toe) skin assessment, including:

    • 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

  • Pain assessment using a validated tool

  • Assessment of pressure injury characteristics and classification using the National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel (NPUAP/EPUAP) classification system

  • Diagnostic testing

  • Vascular assessment (extremity injuries)

  • Individual concerns, preferences, goals of care, and activities of daily living

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