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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.

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.


The purpose of debridement is to remove nonviable, dead (slough and/or necrotic) tissue, callus, and foreign matter (debris) from the wound to reduce infection and promote healing. There are many methods of debridement, but the most common are sharp/surgical, autolytic, and mechanical. Assessing the need for and method of debridement should be based on the individual’s goals of care, preferences, and comfort; their condition, including pain, vascular condition, and risk of bleeding; the type, amount, and location of dead tissue; and health care professional training and experience. Sharp debridement requires specialized knowledge, education, and skills.

For Patients

To help your wound heal, you should have dead skin, callus, and debris removed (this is called debridement) if your health care professional determines that it is necessary and appropriate.


For Clinicians

Debride wounds for people with a pressure injury using an appropriate method of debridement if it is determined as necessary in their assessment, and if it is not contraindicated. Sharp/surgical debridement should be considered first, unless it is contraindicated.


For Health Services

Ensure that health care professionals across settings who care for people with pressure injuries are trained in appropriate methods of wound debridement. This includes providing access to training programs and materials.

Process Indicator

Percentage of people with a pressure injury who have their wound appropriately debrided by a trained health care professional if it is determined as necessary in their assessment

  • Denominator: number of people with a pressure injury and wound debridement determined as necessary in their assessment

  • Numerator: number of people in the denominator who have their wound appropriately debrided (using sharp/surgical, mechanical, or autolytic methods) by a trained health care professional

  • Data source: local data collection

  • Potential stratification: patient type

Contraindication

Inadequate vascular supply.

Appropriate method of debridement

Sharp/surgical debridement should be considered first if there is infection, exudate, and/ or extensive dead tissue, unless there is inadequate vascular supply, and if it is in alignment with the individualized care plan and mutually agreed-upon goals of care. Sharp/surgical debridement may be active/aggressive (extensive and aggressive removal of tissue) or conservative (removal of loose, dead tissue without pain or bleeding). Other appropriate methods include mechanical and autolytic debridement. Pain should be managed during debridement.


Trained health care professional

The health care professional has training specific to the method of debridement being used.

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