Quality Compass - Pressure Ulcers

Overview

Updated on December 03, 2015

Issue

A pressure ulcer, also referred to as a pressure sore, bedsore and decubitus ulcer, is defined as a localized injury to the skin and/or underlying tissue occurring most often over a bony prominence and caused by pressure, shearing, or friction, alone or in combination.¹ Pressure ulcers are graded or staged along a 4-point classification system denoting severity. Stage I (1) represents the beginnings of a pressure ulcer and stage IV (4), the severest grade, consists of tissue loss with exposed bone, tendon, and or muscle.¹

While the causes of pressure ulcers can vary, early assessment, prevention and treatment are all essential if pressure ulcers incidence is to be reduced. The Long-Term Care Homes Act, 2007, requires all homes in Ontario to have a wound care program to promote skin integrity, prevent the development of wounds and pressure ulcers, and provide effective skin and wound care interventions.² To support your quality improvement efforts, this site includes pressure ulcer evidence informed best practices and change ideas for long-term care homes who aim to improve the incidence and prevalence of pressure ulcers.

Call to Action

Pressure ulcers can be painful and undermine function, mobility, and quality of life.³ As well, the interventions to treat them are a significant financial burden to the health care system.³ More importantly, pressure ulcers are avoidable with a greater focus on prevention. In 2012, 2.6% of LTC residents experienced a new pressure ulcer (stage 2 or higher) and 3% had a pressure ulcer that recently got worse.⁵

Ontario is the first jurisdiction that publicly reports quality indicators for long-term care homes. Measuring and monitoring efforts is essential in quality improvement. The tools and information provided in this resource focus on the process of quality improvement for long-term care homes however, the ultimate goal is to provide residents with the best possible care.

What is the pressure ulcer rate in your home?

Click here to review your long-term care home performance on HQO´s public reporting site.

Ontario Health Technology Advisory Committee (OHTAC). OHTAC Recommendation: Prevention and Management of Pressure Ulcers.

Toronto: Ontario Health Technology Advisory Committee; October 2009.
Available from: http://www.hqontario.ca/english/providers/program/ohtac/tech/recommend/rec_pup_20091020.pdf
Government of Ontario. Ontario Regulation 79/10, Long-Term Care Homes Act, 2007.

2010 Mar 10
Available from: http://www.ontario.ca/laws/regulation/r10079
Canadian Institute of Health Information. Compromised Wounds in Canada. 2013.

Toronto: Canadian Institute of Health Information; 2013.
Available from: https://secure.cihi.ca/free_products/AiB_Compromised_Wounds_EN.pdf
Health Quality Ontario. Quality Monitor 2012.

Toronto: Health Quality Ontario; 2012.
Available from: http://www.hqontario.ca/portals/0/Documents/pr/qmonitor-full-report-2011-en.pdf
Canadian Institute of Health Information. Your Health System.

Worsened Pressure Ulcer in Long-Term Care details for Ontario. 2015.
Available from: http://yourhealthsystem.cihi.ca/hsp/indepth?lang=en#/indicator/052/2/C5001/

Best Practices

Updated on December 03, 2015

“Insanity is doing things the way we’ve always done them and expecting different results”

Albert Einstein

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.¹⁰ Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach.

Change ideas are specific and practical changes informed by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.

EVIDENCE-INFORMED BEST PRACTICESType of Evidence

Early identification of Stage 1 pressure ulcers (Assessment)I (High)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Early identification of Stage 1 pressure ulcers (Assessment)	Evaluate the at-risk resident for pressure ulcers using tools such as RAI MDS (PURS) and Braden Scale Early Identification of Stage 1 pressure ulcers to prevent progression Examine each pressure ulcer incident to determine cause and effect to identify contributing factors and prevent worsening Residents who are restricted to bed and/or chair, or those experiencing surgical intervention, should be assessed for pressure, friction and shearing in all positions and during lifting, turning and repositioning Consult with interdisciplinary team to identify required changes to the care plan Provide staff opportunities for education and training (at orientation and regular intervals on best practices related to pressure ulcer identification)	Risk Assessment and Prevention of Pressure Ulcers Nursing Best Practice Guideline, Registered Nurses' Association of Ontario (RNAO) Braden Scale for Predicting Pressure Sore Risk, Veterans Affairs Canada Pressure Ulcer Prevention, Institute for Health Care Improvement Map, Institute for Healthcare Improvement

References

Early identification of Stage 1 pressure ulcers

Type of Evidence: I (High)

References:

Systematic Reviews

Marchione FG, Araújo LM, Araújo LV. Approaches that use software to support the prevention of pressure ulcer: A systematic review. Int J Med Inform. 2015 Oct;84(10):725-36. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/26116169

Moore ZE, Cowman S. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev. 2014 Feb 5;2:CD006471. Full-text available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006471.pub3/full

Niederhauser A, VanDeusen Lukas C, Parker V, Ayello EA, Zulkowski K, Berlowitz D. Comprehensive programs for preventing pressure ulcers: A review of the literature. Adv Skin Wound Care. 2012;25(4):167-88. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22441049

Supporting Research

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Park SH, Choi YK, Kang CB. Predictive validity of the Braden Scale for pressure ulcer risk in hospitalized patients. J Tissue Viability. 2015 Aug;24(3):102-13. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/26050532

Webster J, Coleman K, Mudge A, Marquart L, Gardner G, Stankiewicz, M., McClymont, A. Pressure ulcers: Effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial). BMJ Qual Saf. 2011;20(4):297-306. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21262791

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Health Quality Ontario. Management of chronic pressure ulcers: an evidence-based analysis. Toronto: Ontario Health Technology Assessment Series. 2009;9(3). Available from: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_pup_20090701.pdf

Ontario Health Technology Advisory Committee. OHTAC Recommendation Prevention and Treatment of Pressure Ulcers. Toronto: Ontario Health Technology Advisory Committee; 2009 Oct. Available from: http://www.health.gov.on.ca/english/providers/program/ohtac/tech/recommend/rec_pup_20091020.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; Revised 2011.Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
TOP OF TAB

Ongoing assessment of pressure ulcers (Assessment)IV (Expert Opinion)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Ongoing assessment of pressure ulcers (Assessment)	Develop a monitoring system to ensure prevention measures are implemented effectively Consider use of Pressure Ulcer Scale for Healing (PUSH) tool to allow for assessing the progress of healing for existing pressure ulcers Consult with interdisciplinary team to identify required changes to the care plan Provide staff opportunities for education and training (at orientation and regular intervals on best practices related to pressure ulcer identification)	Pressure Ulcer Scale for Healing (PUSH) Tool, National Pressure Ulcer Advisory Panel

References

Ongoing Assessment of Pressure Ulcers

Type of Evidence: IV (Expert Opinion)

References:

Supporting Research

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; Revised 2011.Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
TOP OF TAB

Identify contributing factors to pressure ulcer development to prevent
recurrence (Prevention)IV (Expert Opinion)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Identify contributing factors to pressure ulcer development to prevent recurrence (Prevention)	Examine each pressure ulcer incident to determine cause and effect to determine contributing factors and prevent recurrence Consult with interdisciplinary team to identify required changes to the care plan Conduct regular inspections of mobility assistive devices for potential causes of pressure	Pressure Ulcer Prevention, Institute for Health Care Improvement Map, Institute for Healthcare Improvement Risk Assessment and Prevention of Pressure Ulcers Nursing Best PracticeGuideline, Registered Nurses' Association of Ontario (RNAO)

References

Identify Contributing Factors to Pressure Ulcer Development to Prevent Recurrence

Type of Evidence: IV (Expert Opinion)

References:

Supporting Research

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Health Quality Ontario. Management of chronic pressure ulcers: an evidence-based analysis. Toronto: Ontario Health Technology Assessment Series. 2009;9(3). Available from: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_pup_20090701.pdf

Ontario Health Technology Advisory Committee. OHTAC Recommendation Prevention and Treatment of Pressure Ulcers. Toronto: Ontario Health Technology Advisory Committee; 2009 Oct. Available from: http://www.health.gov.on.ca/english/providers/program/ohtac/tech/recommend/rec_pup_20091020.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; Revised 2011.Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers

Sibbald RG, Goodman L, Norton L, Krasner DL, Ayello EA. Prevention and Treatment of Pressure Ulcers. Skin Therapy Lett. 2012;17(8):4-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22949132
TOP OF TAB

Establish a regular turning schedule for high-risk residents (Prevention)I (High

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Establish a regular turning schedule for high-risk residents (Prevention)	Minimize pressure through the immediate use of a positioning schedule for residents with an identified risk for pressure ulcer development Use proper positioning, transferring, and turning techniques Consult an Occupational Therapist or Physical Therapist (OT/PT) regarding transfer and positioning techniques and devices to reduce friction and shear and to optimize client independence	Risk Assessment and Prevention of Pressure Ulcers Nursing Best PracticeGuideline, Registered Nurses' Association of Ontario (RNAO)

References

Establish a Regular Turning Schedule for High Risk Residents

Type of Evidence: I (High)

References:

Systematic Reviews

Moore ZE, Cowman S. Repositioning for treating pressure ulcers. Cochrane Database Syst Rev. 2015 Jan 5;1:CD006898. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/25561248

Gillespie BM, Chaboyer WP, McInnes E, Kent B, Whitty JA, Thalib L. Repositioning for pressure ulcer prevention in adults. Cochrane Database Syst Rev. 2014 Apr 3;4:CD009958. Full-text available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009958.pub2/full

Supporting Research

Paulden M, Bergstrom N, Horn SD, Rapp MP, Barrett R, Watkiss M, Pham B, Krahn M. Turning for ulcer reduction (TURN) study: an economic analysis. October 2014. Available at: www.hqontario.ca/Portals/0/Documents/eds/ohtas/economic-analysis-turn-1410-en.pdf

Giesbrecht, EM, Ethans KD, Staley D. Measuring the effect of incremental angles of wheelchair tilt on interface pressure among individuals with spinal cord injury. Spinal Cord. 2011;49(7):827-831. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21242997

Moore Z, Cowman S, Conroy RM. A randomised controlled clinical trial of repositioning, using the 30 degrees tilt, for the prevention of pressure ulcers. J Clin Nurs. 2011;20(17-18):2633-2644. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21702861

Rafter L. Evaluation of patient outcomes: Pressure ulcer prevention mattresses. Br J Nurs. 2011;20(11):S32-S34-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21727848

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Ontario Health Technology Advisory Committee. OHTAC Recommendation Prevention and Treatment of Pressure Ulcers. Toronto: Ontario Health Technology Advisory Committee; 2009 Oct. Available from: http://www.health.gov.on.ca/english/providers/program/ohtac/tech/recommend/rec_pup_20091020.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; Revised 2011.Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
TOP OF TAB

Use pressure relieving mattresses and pressure relieving padding (Prevention)I (High)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Use pressure relieving mattresses and pressure relieving padding	Residents at risk of developing a pressure ulcer should use a pressure relieving mattress, such as one with high-density foam	Risk Assessment and Prevention of Pressure Ulcers Nursing Best Practice Guideline, Registered Nurses' Association of Ontario (RNAO) Pressure Ulcer Prevention, Institute for Health Care Improvement Map, Institute for Healthcare Improvement

References

Use Pressure Relieving Mattresses and Pressure Relieving Padding to Prevent Pressure Ulcers

Type of Evidence: I (High)

References:

Systematic Reviews

Tricco AC, Antony J, Vafaei A, Khan PA, Harrington A, Cogo E, Wilson C, Perrier L, Hui W, Straus SE. Seeking effective interventions to treat complex wounds: an overview of systematic reviews. BMC Med. 2015 Apr 22;13:89. Full-text available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009958.pub2/full

McInnes E, Jammali-Blasi A, Bell-Syer SE, Dumville JC, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2011;(4). Available from: http://www.ncbi.nlm.nih.gov/pubmed/21491384

Supporting Research

Tasker LH, Shapcott NG, Watkins AJ, Holland PM. The effect of seat shape on the risk of pressure ulcers using discomfort and interface pressure measurements. Prosthet Orthot Int. 2014 Feb;38(1):46-53. Full-text available at:http://poi.sagepub.com/content/38/1/46.long

McInnes E, Jammali-Blasi A, Bell-Syer S, Dumville J, Cullum N. Preventing pressure ulcers—are pressure-redistributing support surfaces effective? A cochrane systematic review and meta-analysis. Int J Nurs Stud. 2012;49(3):345-359. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22104042

Reddy M. Pressure ulcers. Clin Evid (Online). 2011 Apr 28;2011:1901. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21524319

Bain D. Laboratory performance of alternating pressure air mattresses component and sequelae. Br J Nurs. 2011;20(20):S29-34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22067933

Brienza D, Kelsey S, Karg P, et al. A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. J Am Geriatr Soc. 2010;58(12):2308-2314. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21070197

Rafter L. Evaluation of patient outcomes: Pressure ulcer prevention mattresses. Br J Nurs. 2011;20(11):S32, S34-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21727848

van Leen M, Hovius S, Neyens J, Halfens R, Schols, J. Pressure relief, cold foam or static air? A single center, prospective, controlled randomized clinical trial in a Dutch nursing home. J Tissue Viability. 2011;20(1):30-34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20510611

Wu T, Wang ST, Lin PC, Liu CL, Chao YF. Effects of using a high-density foam pad versus a viscoelastic polymer pad on the incidence of pressure ulcer development during spinal surgery. Biol Res Nurs. 2011;13(4):419-424. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21196422

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Institute for Healthcare Improvement. Pressure Ulcer Prevention [Internet]. Institute for Healthcare Improvement. Available from: http://app.ihi.org/imap/tool/#Process=cbe9c419-f6ae-49ed-8bb5-5d17844796e2

Ontario Health Technology Advisory Committee. OHTAC Recommendation Prevention and Treatment of Pressure Ulcers. Toronto: Ontario Health Technology Advisory Committee; 2009 Oct. Available from: http://www.health.gov.on.ca/english/providers/program/ohtac/tech/recommend/rec_pup_20091020.pdf

Orsted HL, Ohura T, Harding K. Pressure, Shear, Friction, and Microclimate in Context. London (UK): Wounds International; 2010. Available from: http://www.woundsinternational.com/pdf/content_8925.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; 2002. Revised 2011. Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
TOP OF TAB

Minimize use of restraints (Prevention)III (Low)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Minimize use of restraints (Prevention)	Use of restraints should be minimized whenever possible

References

Minimize Use of Restraints

Type of Evidence: III (Low)

References:

Supporting Research

Castle NG, Engberg J. The health consequences of using physical restraints in nursing homes. Med Care. 2009;47(11):1164-73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19786918
TOP OF TAB

Minimize shearing forces (Prevention)II (Medium)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Minimize shearing forces (Prevention)	Use of shearing forces should be minmized whenever possible

References

Minimize Shearing Forces

Type of Evidence: II (Medium)

References:

Systematic Reviews

McGinnis E, Stubbs N. Pressure-relieving devices for treating heel pressure ulcers. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD005485. Full-text available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005485.pub3/full

Supporting Research

Bales I. A comparison between the use of intravenous bags and the Heelift suspension boot to prevent pressure ulcers in orthopedic patients. Adv Skin Wound Care. 2012;25(3):125-131. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22343600.

Giesbrecht EM, Ethans KD, Staley D. Measuring the effect of incremental angles of wheelchair tilt on interface pressure among individuals with spinal cord injury. Spinal Cord. 2011;49(7):827-831. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21242997

Moore Z, Cowman S, Conroy RM. A randomised controlled clinical trial of repositioning, using the 30 degrees tilt, for the prevention of pressure ulcers. J Clin Nurs. 2011;20(17-18):2633-2644. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21702861

Orsted HL, Ohura T, Harding K. Pressure, Shear, Friction, and Microclimate in Context. London (UK): Wounds International; 2010. Available from: http://www.woundsinternational.com/pdf/content_8925.pdf

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf
TOP OF TAB

Use pressure relieving mattresses and pressure relieving padding (Treatment)I (High)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Use pressure relieving mattresses and pressure relieving padding (Treatment)	Ensure consistent use of positioning cushions/aids and pressure relieving surfaces	Risk Assessment and Prevention of Pressure Ulcers Nursing Best Practice Guideline, Registered Nurses' Association of Ontario (RNAO)

References

Use Pressure Relieving Mattresses and Pressure Relieving Devices

Type of Evidence: I (High)

References:

Systematic Reviews

Tricco AC, Antony J, Vafaei A, Khan PA, Harrington A, Cogo E, Wilson C, Perrier L, Hui W, Straus SE. Seeking effective interventions to treat complex wounds: an overview of systematic reviews. BMC Med. 2015 Apr 22;13:89. Full-text available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009958.pub2/full

McInnes E, Jammali-Blasi A, Bell-Syer SE, Dumville JC, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2011;(4). Available from: http://www.ncbi.nlm.nih.gov/pubmed/21491384

Supporting Research

Tasker LH, Shapcott NG, Watkins AJ, Holland PM. The effect of seat shape on the risk of pressure ulcers using discomfort and interface pressure measurements. Prosthet Orthot Int. 2014 Feb;38(1):46-53. Full-text available at:http://poi.sagepub.com/content/38/1/46.long

McInnes E, Jammali-Blasi A, Bell-Syer S, Dumville J, Cullum N. Preventing pressure ulcers—are pressure-redistributing support surfaces effective? A cochrane systematic review and meta-analysis. Int J Nurs Stud. 2012;49(3):345-359. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22104042

Reddy M. Pressure ulcers. Clin Evid (Online). 2011 Apr 28;2011:1901. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21524319

Bain D. Laboratory performance of alternating pressure air mattresses component and sequelae. Br J Nurs. 2011;20(20):S29-34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22067933

Brienza D, Kelsey S, Karg P, et al. A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. J Am Geriatr Soc. 2010;58(12):2308-2314. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21070197

Rafter L. Evaluation of patient outcomes: Pressure ulcer prevention mattresses. Br J Nurs. 2011;20(11):S32, S34-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21727848

van Leen M, Hovius S, Neyens J, Halfens R, Schols, J. Pressure relief, cold foam or static air? A single center, prospective, controlled randomized clinical trial in a Dutch nursing home. J Tissue Viability. 2011;20(1):30-34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20510611

Wu T, Wang ST, Lin PC, Liu CL, Chao YF. Effects of using a high-density foam pad versus a viscoelastic polymer pad on the incidence of pressure ulcer development during spinal surgery. Biol Res Nurs. 2011;13(4):419-424. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21196422

Institute for Healthcare Improvement. Pressure Ulcer Prevention [Internet]. Institute for Healthcare Improvement. Available from: http://app.ihi.org/imap/tool/#Process=cbe9c419-f6ae-49ed-8bb5-5d17844796e2

Ontario Health Technology Advisory Committee. OHTAC Recommendation Prevention and Treatment of Pressure Ulcers. Toronto: Ontario Health Technology Advisory Committee; 2009 Oct. Available from: http://www.health.gov.on.ca/english/providers/program/ohtac/tech/recommend/rec_pup_20091020.pdf

Orsted HL, Ohura T, Harding K. Pressure, Shear, Friction, and Microclimate in Context. London (UK): Wounds International; 2010. Available from: http://www.woundsinternational.com/pdf/content_8925.pdf

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; 2002. Revised 2011. Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
TOP OF TAB

Establish standardized treatment for each pressure ulcer stage
(Treatment)IV (Expert Opinion)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Establish standardized treatment for each pressure ulcer stage (Treatment)	Use standardized approach to treating ulcers for each stage using evidence based treatments Conduct regular (e.g., weekly) high-risk rounds for all residents with ulcers to assess improvement	Pressure Ulcer Treatment: Quick Reference Guide, European Pressure Ulcer Advisory Panel Risk Assessment and Prevention of Pressure Ulcers Nursing Best Practce Guideline, Registered Nurses' Association of Ontario (RNAO)

References

Establish Standardized Treatment for each Pressure Ulcer Stage

Type of Evidence: IV (Expert Opinion)

References:

Supporting Research

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; 2002. Revised 2011. Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers

Sibbald RG, Goodman L, Norton L, Krasner DL, Ayello EA. Prevention and Treatment of Pressure Ulcers. Skin Therapy Lett. 2012;17(8):4-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22949132
TOP OF TAB

Protect and promote skin integrity from excessive moisture
and incontinence (Treatment)IV (Expert Opinion)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Protect and promote skin integrity from excessive moisture and incontinence (Treatment)	Individualize the resident’s bathing schedule Avoid hot water and use a pH balanced, non-sensitizing skin cleanser Minimize force and friction on the skin during cleansing Maintain skin hydration by applying non-sensitizing, pH balanced, lubricating moisturizers and creams with minimal alcohol content Use protective barriers (e.g., liquid barrier films, transparent films, hydrocolloids) or protective padding to reduce friction injuries Ensure hydration through adequate fluid intake	Pressure Ulcer Prevention, Institute for Health Care Improvement Map, Institute for Healthcare Improvement Risk Assessment and Prevention of Pressure Ulcers Nursing Best Practice Guideline, Registered Nurses' Association of Ontario (RNAO)

References

Protect and Promote Skin Integrity from Excessive Moisture and Incontinence

Type of Evidence: IV (Expert Opinion)

References:

Systematic Reviews

Beeckman D, Van Lancker A, Van Hecke A, Verhaeghe S. A systematic review and meta-analysis of incontinence-associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Res Nurs Health. 2014 Jun;37(3):204-18. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/24700170

Supporting Research

Institute for Healthcare Improvement. Pressure Ulcer Prevention [Internet]. Institute for Healthcare Improvement. Available from: http://app.ihi.org/imap/tool/#Process=cbe9c419-f6ae-49ed-8bb5-5d17844796e2

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; 2002. Revised 2011. Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
TOP OF TAB

Minimize pain (Treatment)IV (Expert Opinion)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Minimize pain (Treatment)	Manage pain (e.g., effective medication, therapeutic positioning, support surfaces, and other non-pharmacological interventions) Monitor level of pain on an on-going basis, using a valid pain assessment tool	Pressure Ulcer Treatment: Quick Reference Guide, European Pressure Ulcer Advisory Panel Risk Assessment and Prevention of Pressure Ulcers Nursing Best Practice Guideline, Registered Nurses' Association of Ontario (RNAO)

References

Minimize Pain

Type of Evidence: IV (Expert Opinion)

References:

Supporting Research

Sibbald RG, Goodman L, Norton L, Krasner DL, Ayello EA. Prevention and Treatment of Pressure Ulcers. Skin Therapy Lett. 2012;17(8):4-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22949132

Guidelines

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; 2002. Revised 2011. Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
TOP OF TAB

Ensure optimal nutrition (Treatment)IV (Expert Opinion)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Ensure optimal nutrition (Treatment)	A nutritional assessment with appropriate interventions should be implemented on entry to any new health care environment and when the client’s condition changes	Pressure Ulcer Prevention, Institute for Health Care Improvement Map, Institute for Healthcare Improvement Pressure Ulcer Treatment: Quick Reference Guide, European Pressure Ulcer Advisory Panel Risk Assessment and Prevention of Pressure Ulcers Nursing Best Practice Guideline, Registered Nurses' Association of Ontario (RNAO)

References

Ensure Optimal Nutrition

Type of Evidence: IV (Expert Opinion)

References:

Systematic Reviews

Langer G, Fink A. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev. 2014 Jun 12;6:CD003216. Full-text available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003216.pub2/full

Supporting Research

Cereda E, Klersy C, Serioli M, Crespi A, D'Andrea F; OligoElement Sore Trial Study Group. A nutritional formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers: a randomized trial. Ann Intern Med. 2015 Feb 3;162(3):167-74. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/25643304

Institute for Healthcare Improvement. Pressure Ulcer Prevention [Internet]. Institute for Healthcare Improvement. Available from: http://app.ihi.org/imap/tool/#Process=cbe9c419-f6ae-49ed-8bb5-5d17844796e2

Ontario Health Technology Advisory Committee. OHTAC Recommendation Prevention and Treatment of Pressure Ulcers. Toronto: Ontario Health Technology Advisory Committee; 2009 Oct. Available from: http://www.health.gov.on.ca/english/providers/program/ohtac/tech/recommend/rec_pup_20091020.pdf

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; 2002. Revised 2011. Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
TOP OF TAB

Employ best practices for bed ridden residents (Treatment)IV (Expert Opinion)

Make Change

Evidence-Informed Best Practice	How To Implement	Toolbox
Employ best practices for bed ridden residents (Treatment)	Utilize an interdisciplinary approach to plan of care Use devices to enable independent positioning, lifting and transfers (e.g., trapeze, transfer board, bed rails) Reposition at least every 2 hours or sooner if at high risk Use pillows or foam wedges to avoid contact between bony prominences Use devices to totally relieve pressure on the heels and bony prominences of the feet A 30º turn to either side is recommended to avoid positioning directly on the trochanter Reduce shearing forces by maintaining the head of the bed at the lowest elevation consistent with medical conditions and restrictions (A 30º elevation or lower is recommended) Use lifting devices to avoid dragging residents during transfer and position changes Do not use donut type devices or products that localize pressure to other areas	Risk Assessment and Prevention of Pressure Ulcers Nursing Best Practice Guideline, Registered Nurses' Association of Ontario (RNAO) Pressure Ulcer Prevention, Institute for Health Care Improvement Map, Institute for Healthcare Improvement Pressure Ulcer Treatment: Quick Reference Guide, European Pressure Ulcer Advisory Panel

References

Employ Best Practices for Bed Ridden Residents

Type of Evidence: IV (Expert Opinion)

References:

Supporting Research

Qaseem A, Mir TP, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69. Full-text available at: http://annals.org/article.aspx?articleid=2173505

Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):370-9. Full-text available at: http://annals.org/article.aspx?articleid=2173506

NICE. Pressure ulcers: prevention and management. April 2014. Available at: https://www.nice.org.uk/guidance/CG179/chapter/about-this-guideline#about-this-guideline

Bergstrom, N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M. Preventing pressure ulcers: a multi-site RCT in nursing homes. June 2011. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/3744/896380/TR_2012.1_TURN_Clinical_Report_15Jun2012_FINAL_Revised_on_Feb_28_2013.pdf

Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers. Toronto: Registered Nurses’ Association of Ontario; 2002. Revised 2011. Available from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
TOP OF TAB

Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

Lancet. 2003 Oct 11;362(9391):1225-30.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/14568747

Measurement

Updated on December 03, 2015

“Some is not a number, soon is not a time.”

Don Berwick, former President and CEO of IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Type of Indicator	Indicator of Quality Improvement	How to Calculate: numerator __________ denominator	Targets/ Benchmarks	How is This Indicator Used?
Outcome	Percentage of Residents Whose Stage 2 to 4 Pressure Ulcer Worsened	Residents who have a pressure ulcer at stage 2 to 4 on their target assessment and for whom the stage of pressure ulcer is greater on their target assessment than on their prior assessment Residents with valid assessments	Targets: As low as possible (set by individual homes) Provincial benchmarks: 1%	Quality improvement QIP indicator Publicly reported by HQO

Run Charts

Collected measures can be presented graphically by plugging the monthly results into run chart.

What to know more?

Explore the Tools and Resources tab to find additional support for your QI initiative.

Tools & Resources

Updated on December 03, 2015

“Knowledge derived from research and experience may be of little value unless it is put into practice.”

Dr. Judith Shamian, keynote address at the 11th International Nursing Infomatics Conference, in Montreal, 2011

Tools

Pressure Ulcers

PUSH Tool To assess the progress of healing of pressure ulcers. National Pressure Ulcer Advisory Panel
Braden Scale for Predicting Pressure Sore Risk Veterans Affairs Canada

QI Tools

Communications Plan: Instructions , Tool
Fishbone Template: Instructions , Tool
Five Whys: Instructions , Tool
Measurement Plan Template: Instructions , Tool
Pareto Chart: Instructions , Tool
PDSA Template
Project Charter
Tree Diagram Worksheet

For a more comprehensive list of tools and resources, visit the following links on our HQO website:

HQO Tools and Resources

Resources

Pressure Ulcers

Best Practice Guidelines for Risk Assessment and Prevention of Pressure Ulcers Registered Nurses' Association of Ontario (RNAO)
Client Centred Care Supplement Nursing Best Practice Guideline, Registered Nurses' Association of Ontario (RNAO)
Pressure Ulcer Treatment: Quick Reference Guide European Pressure Ulcer Advisory Panel. (2009)
Pressure Ulcer Prevention, Institute for Health Care Improvement Map by Selected Characteristics, 2005-2006, Canadian Institute for Health Information

QI Resources

Interpreting Run Charts
Health Quality Ontario
Model for Improvement (Clip 1)
Institute for Healthcare Improvement
Model for Improvement (Clip 2)
Institute for Healthcare Improvement
PDSA Cycle Video (Part 1)
Institute for Healthcare Improvement
PDSA Cycle Video (Part 2)
Institute for Healthcare Improvement
The run chart: a simple analytical tool for learning from variation in healthcare processes
Perla RJ, Provost LP, Murray SK. BMJ Qual Saf. 2011 Jan;20(1):46-51.

Pressure Ulcers

Overview

Issue

Call to Action

What is the pressure ulcer rate in your home?

Ontario Health Technology Advisory Committee (OHTAC). OHTAC Recommendation: Prevention and Management of Pressure Ulcers.

Government of Ontario. Ontario Regulation 79/10, Long-Term Care Homes Act, 2007.

Canadian Institute of Health Information. Compromised Wounds in Canada. 2013.

Health Quality Ontario. Quality Monitor 2012.

Canadian Institute of Health Information. Your Health System.

Best Practices

Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

Measurement

Run Charts

What to know more?

Tools & Resources

Tools

Pressure Ulcers

QI Tools

Resources

Pressure Ulcers

QI Resources