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 Statements in Brief

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.

Resources Quality Statements Advisory Committee About

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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.

Background

An individualized care plan guides effective, integrated coordination and delivery of care. The content of the care plan will reflect whether the individual is at risk of developing a pressure injury (focusing on prevention strategies) or has a current pressure injury (focusing on management and treatment plans). Consideration of factors that may affect the healing potential of the wound (pressure injuries may be healable, maintenance, or non-healable—please see Quality Statement 3 for definitions) is essential for optimizing healing conditions and quality of life. These factors include poor circulation, numbness or lack of sensation, and systemic infection.

Goals should be mutually agreed-upon by the health care professional(s) and the person receiving care. For example, people receiving palliative care are at higher risk of developing pressure injuries, but goals related to prevention and healing (and associated strategies and treatments) may not be appropriate or realistic compared to goals that focus on quality of life, comfort, and symptom management. Regular review of the care plan also provides an opportunity to revisit goals, review progress, and make adjustments based on the changing needs and preferences of the person receiving care.

What This Quality Statement Means

For Patients

Your health care professional should work with you to develop a care plan that reflects your needs, concerns, and preferences. A care plan is a written document that you have developed with your health care professional. It describes your goals for your care, the care you will receive, and who will provide it.

For Clinicians

Work with people who have developed or are at risk of developing a pressure injury to create a mutually agreed-upon individualized care plan that identifies patient-centred concerns. For patients at risk, the care plan should include prevention strategies. For patients with a pressure injury, the care plan should include a treatment plan and a plan for local wound care. The plan should be reviewed and updated regularly.

For Health Services

Ensure that systems, processes, and resources are in place to support clinicians in developing individualized care plans for people who have developed or are at risk of developing a pressure injury. This may also include tools such as standardized care plan templates.

Quality Indicators

Process Indicators

Percentage of people who have developed or are at risk of developing a pressure injury who have a mutually agreed-upon individualized care plan that identifies patient-centred concerns

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 a mutually agreed-upon individualized care plan that identifies patient-centred concerns
Data source: local data collection

Percentage of people with a pressure injury who have had their individualized care plan reviewed and updated regularly

Denominator: number of people with a pressure injury
Numerator: number of people in the denominator who have had their individualized care plan reviewed and updated regularly (frequency may range from daily to every 3 months)
Data source: local data collection

Definitions Used Within This Quality Statement

Risk factors

These include:

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

Individualized care plan

This includes:

Results of the risk and comprehensive assessments (see Quality Statements 1 and 3), including identified risk factors and the dimensions, characteristics, and healing trajectory of the pressure injury (these should be reassessed on a regular basis)
Mutually agreed-upon goals of care and individual concerns and preferences
Factors that may affect wound healing and patient-centred concerns, such as pain management, optimizing activities of daily living, and psychosocial needs and supports
Provision of information on pressure injury prevention and management
For people at risk, prevention strategies:
- Skin care
- Managing and reducing pressure and shear in high-pressure areas (use of pressure redistribution devices, mobilization, and repositioning)
- Individualized nutrition care plan
- Continence management
For people with a pressure injury, a treatment plan, including local wound care, that is based on the healing potential of the wound:
- Debridement, infection management, and moisture management
- Managing and reducing pressure and shear in high-pressure areas (use of pressure redistribution devices, mobilization, and repositioning)
- Pain management
- Individualized nutrition care plan
- Continence management

Reviewed and updated regularly

Frequency may range from daily (during dressing changes and based on regular wound assessments) to every 1 to 3 months (for a full care plan review) and is based on the characteristics of the wound, the acuity of the problem, and whether or not there are significant changes. Reviewing the care plan may require a partial reassessment (repeating aspects of the comprehensive assessment) or a full reassessment, including revisiting the goals of care.

Evidence to Improve Care