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

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.

Background

Repositioning is an important part of pressure injury prevention and treatment, because it reduces the length of time and amount of pressure on at-risk areas, such as bony prominences and heels. Repositioning may also contribute to increased comfort, dignity, and functional ability, and it provides an opportunity for health care providers to interact with individuals and observe their skin condition. People who are seated or lying down need to be repositioned in a way that relieves or redistributes pressure and limits the skin’s exposure to pressure and shear.

What This Quality Statement Means

For Patients

You should reposition yourself often (or be helped by a health care professional or caregiver) to prevent or heal a pressure injury.

For Clinicians

Provide interventions that enable repositioning at regular intervals for people who have developed or are at risk of developing a pressure injury. These interventions should be based on people’s functional ability. People who are mobile should be encouraged to reposition themselves; if they are not able to do so, help them to reposition themselves.

For Health Services

Ensure that systems, procedures (protocols), and resources are in place to support clinicians in providing interventions that enable repositioning at regular intervals for people who have developed or are at risk of developing a pressure injury.

Quality Indicators

Process Indicators

Percentage of people who have developed or are at risk of developing a pressure injury and receive interventions that enable repositioning at regular intervals

Denominator: number of people who have developed or are at risk of developing a pressure injury
Numerator: number of people in the denominator who receive interventions that enable repositioning at regular intervals (frequency may vary depending on the level of mobility and risk of developing a pressure injury)
Data source: local data collection

Percentage of long-term care residents who are at risk of developing a pressure injury who reposition themselves or are repositioned every 2 hours

Denominator: number of long-term care residents who are at risk of developing a pressure injury (Braden score of less than 10)
Numerator: number of long-term care residents in the denominator who reposition themselves or are repositioned every 2 hours
Data source: local data collection

Percentage of long-term care residents who are at lower risk for pressure injuries and have a high-density foam mattress who reposition themselves or are repositioned every 4 hours

Denominator: number of long-term care residents who are at lower risk for pressure injuries (Braden score of 10 or higher) and have a high-density foam mattress
Numerator: number of long-term care residents in the denominator who reposition themselves or are repositioned every 4 hours
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

Enable repositioning at regular intervals

Encouraging people who are mobile to reposition themselves or helping them to do so (if they cannot reposition themselves) as a way of relieving pressure, particularly over at-risk areas such as bony prominences and heels, and at a frequency that corresponds with their level of mobility and risk of developing a pressure injury. Evidence from the long-term care setting supports repositioning at least every 4 hours for residents with a Braden score of 10 or higher if a high-density foam mattress is also used, and at least every 2 hours for residents with a Braden score of less than 10.

Evidence to Improve Care