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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.

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.


The use of support surfaces, with regular repositioning, is an effective way to prevent and treat pressure injuries. Support surfaces reduce pressure, friction, and shear by protecting and supporting at-risk areas such as bony prominences, and by redistributing pressure more evenly across a larger surface area. People undergoing surgical procedures that are longer than 90 minutes and those seated for long periods of time or who use a wheelchair also require high-quality support surfaces, such as cushions, pads (foam or gel), or seating surfaces that redistribute pressure.

For Patients

As part of your care plan, you should be given something called “support surfaces.” These are special mattresses, cushions, or pads that redistribute pressure across the whole surface of your skin. They can help heal or prevent a pressure injury.


For Clinicians

Provide people who have developed or are at risk of developing a pressure injury with appropriate support surfaces based on their assessment. These include high-density foam mattresses, cushions, pads, or seating surfaces that redistribute pressure.


For Health Services

Ensure the provision of appropriate support surfaces for people who have developed or are at risk of developing a pressure injury. These include high-density foam mattresses, cushions, pads, or seating surfaces that redistribute pressure.

Process Indicators

Percentage of people who have developed or are at risk of developing a pressure injury and have appropriate support surfaces based on their assessment

  • Denominator: number of people who have developed or are at risk of developing a pressure injury

  • Numerator: number of people in the denominator who have appropriate support surfaces based on their assessment

  • Data source: local data collection


Percentage of people who are undergoing surgical procedures longer than 90 minutes, who are seated for long periods of time, or who use a wheelchair and have cushions, pads, or seating surfaces that redistribute pressure

  • Denominator: number of people who are undergoing surgical procedures longer than 90 minutes, who are seated for long periods of time, or who use a wheelchair

  • Numerator: number of people in the denominator who have cushions, pads, or seating surfaces that redistribute pressure

  • Data source: local data collection


Structural Indicator

Availability of high-quality foam mattresses in hospitals, long-term care homes, and community care for those at risk

Risk factors

These include:

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

  • 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


Support surfaces

Support surfaces include high-density foam mattresses (mattresses that provide reduced interface pressure to prevent the breakdown of tissue, as compared to standard mattresses), cushions, pads (foam or gel), or seating surfaces that redistribute pressure.

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