Pressure Injury Management: Risk Assessment, Prevention and Treatment
Publication Date: November 21, 2024
Last Updated: November 25, 2024
Foundational
Good practice statement 1.0
It is good practice for organizations to implement an interprofessional approach for the assessment, prevention and treatment of pressure injuries. This approach includes shared decision making with persons at risk of or living with pressure injuries and their essential caregivers. (U, CC)
620
Good practice statement 2.0
It is good practice for organizations and health providers to communicate and collaborate in a culturally safe and inclusive manner with persons and their essential caregivers in the assessment, prevention and treatment of pressure injuries. (U, CC)
620
Good practice statement 3.0
It is good practice for health providers in collaboration with persons and their essential caregivers, to use a systematic approach in the management of pressure injuries, which includes assessment, prevention and treatment. (U, CC)
620
Assessment
Good practice statement 4.0
It is good practice for health providers in collaboration with persons and their essential caregivers to use a multicomponent approach to assess and reassess a person’s risk of developing pressure injuries. (U, CC)
620
Good practice statement 5.0
It is good practice for health providers to classify a pressure injury using a validated classification system. This classification system should not be used for monitoring pressure injury healing. (U, CC)
620
Recommendation 1.0
The expert panel suggests that nurses and health providers use thermography as an adjunct to skin assessment for early detection of pressure injuries. (C, VL )
620
Recommendation 1.1
The expert panel suggests that nurses and health providers use subepidermal moisture detection as an adjunct to skin assessment for early detection of pressure injuries. (C, VL )
620
Prevention and Treatment
Recommendation 2.0
The expert panel suggests that nurses and health providers reposition persons at risk of pressure injuries every 2-4 hours. (C, L )
620
Good practice statement 6.0
It is good practice for nurses and health providers to select an appropriate support surface in collaboration with the person and their essential caregivers, by considering the following:
- individual risk factors
- contextual factors
- person’s preferences
- comfort.
620
Recommendation 3.0
The expert panel suggests that nurses and health providers implement preventative care bundles for persons at risk of pressure injuries. (C, VL )
620
Recommendation 4.0
The expert panel suggests that nurses and health providers apply multilayer foam silicone dressings as a prophylactic measure for individuals at risk of pressure injuries, in addition to other preventative care strategies. These dressings should be applied to specific at-risk body locations, considering the potential for shearing, friction, and pressure. (C, VL )
620
Recommendation 5.0
The expert panel suggests that nurses and health providers, in collaboration with the person and their essential caregivers, consider using negative pressure wound therapy for treatment of pressure injuries if the person meets indications and there are no contraindications. (C, VL )
620
Recommendation 5.1
The expert panel suggests that nurses and health providers, in collaboration with the person and their essential caregivers, consider using electrical stimulation for treatment of pressure injuries if the person meets indications and there are no contraindications. (C, L )
620
Recommendation Grading
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Overview
Title
Pressure Injury Management: Risk Assessment, Prevention and Treatment
Authoring Organization
Registered Nurses' Association of Ontario
Publication Month/Year
November 21, 2024
Last Updated Month/Year
November 25, 2024
Document Type
Guideline
Country of Publication
CA
Document Objectives
The purpose of this guideline is to provide nurses, members of the interprofessional team and other collaborators (i.e., administrators and policy-makers) with evidence-based recommendations for risk assessment, prevention, and treatment of pressure injuries .
Health Care Settings
Home health, Hospital, Long term care
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Prevention
Diseases/Conditions (MeSH)
D003668 - Pressure Ulcer
Keywords
pressure injury, Pressure Injuries, wound care
Source Citation
Registered Nurses’ Association of Ontario (2024). Pressure injury management: Risk assessment, prevention and treatment, Fourth Edition. Toronto, ON: Registered Nurses’ Association of Ontario.