Implementing and sustaining evidence-based practices in long-term care.

Pressure Injuries

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    The purpose of this Guideline is to present evidence-based recommendations that apply to the decisions and best practices of interprofessional teams working to assess and manage existing pressure injuries in people 18 years of age and above. This Best Practice Guideline (BPG) replaces the RNAO BPG Assessment and Management of Stage I to IV Pressure Ulcers (2007). It provides evidence-based practice, education and policy recommendations for interprofesssional teams across all care settings who are assessing and providing care to people with existing pressure injuries. Moreover, this Guideline refers to “pressure ulcers” as “pressure injuries.” This new terminology aligns with the National Pressure Ulcer Advisory Panel (NPUAP).

    This Guideline provides best practice recommendations in three main areas:

    • Practice recommendations are directed primarily to the front-line interprofessional teams who provide care for people with existing pressure injuries across all practice settings.
    • Education recommendations are directed to those responsible for interprofessional team and staff education, such as educators, quality improvement teams, managers, administrators, and academic institutions.
    • System, organization, and policy recommendations apply to a variety of audiences, depending on the recommendation. Audiences include managers, administrators, policy-makers, health-care professional regulatory bodies, and government bodies.

    Registered Nurses’ Association of Ontario. (2016). Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition. Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/pressure-injuries

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    Define early interventions for pressure ulcer prevention, and to manage Stage I pressure ulcers.

    This best practice guideline assists nurses who work in diverse practice settings to identify adults who are at risk of pressure ulcers. This guideline focuses its recommendations on: • Practice Recommendations including assessment, planning, intervention and discharge/transfer of care • Educational Recommendations for supporting the skills required for nurses working with adults at risk for pressure ulcers • Organization & Policy Recommendations addressing the importance of a supportive practice environment as an enabling factor for providing high quality nursing care, which includes ongoing evaluation of guideline implementation.

    Revised: 2011 Supplement: 2005

    This best practice guideline assists RN’s and RPN’s to identify adults who are at risk for pressure ulcers and provides direction to nurses in defining early interventions.

    Registered Nurses’ Association of Ontario (2013). Risk Assessment and Prevention of Pressure Ulcers Best Practice Guideline (rev.2011) Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers

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    Pressure Injury Gap Analysis

    Organizational assessment tool to assist with implementation and evaluation of the RNAO Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition by comparing current practice to evidence-based practice.
    Source: Registered Nurses' Association of Ontario's Long-Term Care Best Practices Program, Toronto, ON. 2016. Retrieved from http://rnao.ca/bpg/guidelines/pressure-injuries

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    Pressure Ulcer Gap Analysis

    Organizational assessment tool to assist with implementation and evaluation of the RNAO Risk Assessment & Prevention of Pressure Ulcers by comparing current practice to evidence-based practice.
    Source: Registered Nurses' Association of Ontario's Long-Term Care Best Practices Program, Toronto, ON. September 2013.

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    Abbey Pain Scale is an assessment tool for the measurement of pain in people with dementia who cannot verbalize

    Source: Dementia Care Australia Pty Ltd. Website: www.dementiacareaustralia.com

    Reference: Abbey, J; De Bellis, A; Piller, N; Esterman, A; Giles, L; Parker, D and Lowcay, B. Funded by the JH & JD Gunn Medical Research Foundation 1998 – 2002 (This document may be reproduced with this acknowledgment retained)Retrieved from: http://www.wales.nhs.uk/sitesplus/documents/862/FOI-286f-13.pdf

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    This resource describes two mnemonics for wound assessment. ‘NERDS’ is used to systematically assess for superficial critical colonization (localized infection) and STONEES to access deeper and surrounding infection (systemic infection) in people with pressure injuries. NERDS: N – non-healing wound; E – exudate; R – red and bleeding. D – debris; and S – smell. STONEES: S – size; T – temperature: O – os; N – new or satellite areas of breakdown: E – exudate; E – erythema and/or edema (cellulitis); and S – smell.

    Reference: Registered Nurses Association of Ontario (RNAO). 2016. Appendix K: Assessment for Infection. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition. Accessed July 28, 2016 http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf  pp. 135-136.

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    The following is not an exhaustive list of methods on assessing a person’s goals of care. This mnemonic has been suggested as an example identified within the systematic review, AGREE II appraised guidelines, by the expert panel or external stakeholder feedback. It is an example of how to identify the goals of symptom management in people for whom wound healing is not a clinical expectation and where maintaining the person’s comfort is key

    Reference: Registered Nurses 'Association of Ontario. (2016). Appendix P of Assessment and Management of Pressure Injuries for the Interprofessional Team. Toronto, Canada: Author. pp 139.

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    Bates-Jenson Wound Assessment Tool (BWAT) is a validated tool that measures the status of a wound. It is most appropriate for use by experienced wound-care clinicians as a discriminative tool to fully describe wounds during the initial wound assessment. 

    Copyright 2001 Barbara Bates-Jensen

    Reference: Bates-Jensen, Barbara (2001). Bates-Jenson Wound Assessment Tool (BWAT). Retrieved from: http://geronet.med.ucla.edu/centers/borun/modules/Pressure_ulcer_prevention/puBWAT.pdf

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    This one page document describes the areas that should be assessment when using medical devices in LTC in order to prevent pressure related injuries.

    Reference: National pressure ulcer advisory panel (2013). Best Practices for prevention of medical device-related pressure ulcers in long-term care . Copyright 2013. Retrieved from http://www.npuap.org/wp-content/uploads/2013/04/BestPractices-LongTermCare1.pdf

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    The Braden Scale can be used to assess a resident’s level of risk for developing pressure injuries by evaluating six areas of risk: sensory perception, moisture, activity, mobility, nutrition, and friction or shear.

    Reference: Braden Scale (1988). Retrieved from http://www.education.woundcarestrategies.com/coloplast/resources/BradenScale.pdf

    © Copyright Barbara Braden and Nancy Bergstrom, 1988

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    A list of cleansing solutions and their actions for chronic wounds (including pressure injuries), identified by an expert panel and stakeholders providing feedback.

    Reference: Registered Nurses’ Association of Ontario. (2016). Appendix R of Assessment and Management of Pressure Injuries for Interprofessional Team, Third Edition. Toronto, Canada: R. G. Sibbald, H. Orsted, P. M. Coutts and D. H. Keast. Pp 147. http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf

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    This resource uses a generic classification to describe wound dressings, local wound care outcomes and care considerations.

    Web Source: Appendix S of Assessment and Management of Pressure injuries for the Interprofessional Team, Third Edition http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf 

    Reference: Registered Nurses’ Association of Ontario. (2016). Appendix S of Assessment and Management of Pressure Injuries for Interprofessional Team, Third Edition. Toronto, Canada: R. G. Sibbald, J. A. Elliott, E. A. Ayello, and R. Somayaj Glasgow P.148

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    This resource has been designed to teach Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Unregulated Care Providers how to implement the recommendations outlined in the RNAO Best Practice Guideline, Assessment and Management of Stage I to IV Pressure Ulcers.

    There are two parts to this program; Part A is directed towards RNs and RPNs while Part B is aimed towards Unregulated Care Providers (UCP). These materials are for use by the workshop facilitator, and include a list of components, questionnaires and case studies for participants, and answer keys.

    Retrieved from: http://rnao.ca/bpg/guidelines/resources/assessment-and-management-pressure-ulcers-education-program

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    This free e-learn contains six modules which cover everything from the skin structure and blood composition right up to pressure ulcers and a guide to prevention. Each training module has interactive diagrams and has a certificate when the module is completed. To test comprehensive learning the user can read a case study and try and heal a wound.

    Website: http://www.globalwoundacademy.com/

    Permissible uses of EGWA materials EGWA is for your personal use. Unless you first obtain Smith & Nephew’s express written permission, you may not modify, copy, distribute, transmit, display, perform, reproduce, publish, license, create derivative works from, transfer, or sell any information, products or services obtained from EGWA. To do so will automatically terminate this Agreement and could result in civil and criminal penalties.

    Copyright notice Unless otherwise noted, all contents of EGWA, including but not limited to words, images and sounds, are: © 2001-present Smith & Nephew. All rights reserved. You may not reproduce, copy, download or distribute any content of this site without first obtaining express written permission from Smith & Nephew. Violations of Smith & Nephew’s copyrights may result in civil and criminal penalties.

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    This resource outlines the key factors in deciding the method of debridement. Includes definition and examples of debridement. Taken from RNAO's Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition Best Practice Guideline, (Appendix U, pp 151

    Reference: Registered Nurses’ Association of Ontario (2007). Appendix U - Key Factors in Deciding Method of Debridement. RNAO Assessment & Management of Pressure Injuries for the Interprofessional Team, Third Edition Best Practice Guideline. Toronto, Canada. Sibbald, Orsted et al. Page 151 http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf

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    This resource provides a non-exhaustive list of topical antiseptic agents and their effects on wounds. This list was identified by experts and stakeholder feedback

    Reference: Registered Nurses’ Association of Ontario. (2016). Appendix T of Assessment and Management of Pressure Injuries for Interprofessional Team, Third Edition. Toronto, Canada: R. Sibbald, J. A. Elliott, E. A. Ayello, and R. Somayaji, P.150 http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf

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    The McCaffrey Initial Pain Assessment tool can be used to guide health care professionals through an initial assessment of pain. This tool includes diagrams of the human body to help patients locate the pain they experience as well as questions to prompt the patient to describe the intensity, quality, causes, effects, and contributing factors of the pain.

    Reference: McCaffrey M, Pasero C. (1999). McCaffrey Initial Pain Assessment Tool

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    This position statement discussed the rationale for why mucosal pressure ulcers cannot be staged using the classification system. 

    Reference: National pressure ulcer advisory panel (August 2008). Mucosal Pressure Ulcers An NPUAP Position Statement. Copyright 2013. Retrieved from http://www.npuap.org/wp-content/uploads/2012/01/Mucosal_Pressure_Ulcer_Position_Statement_final.pdf

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    The National Pressure Ulcer Advisory Panel (NPUAP) serves as the authoritative voice for improved patient outcomes in pressure ulcer prevention and treatment through public policy, education and research.

    Website: http://www.npuap.org
     

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    NPUAP Pressure Injury Stages webpage provides definitions for the new pressure injury stages.

    Reference: National pressure ulcer advisory panel (n.d.). NPUAP Pressure Injury Stages. Copyright 2013. Retrieved from http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-injury-stages/

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    Asks persons to rate their pain from 0 to 10

    • Scored 0-10 with the anchors of 0 being ‘no pain’ and 10 being ‘pain as bad as it can be’ Used in adults, older adults, and adolescents and children over age 8.
    • Well established evidence of reliability, validity, and ability to detect change
    • No equipment is needed to administer this measure
    • High feasibility (quick and easy to use)

     

    Reference:

    Registered Nurses’ Association of Ontario. (2013). Appendix E of Assessment and Management of Pain, Third Edition.Toronto, Canada: Author. 81-82.

    McCaffery, M., Beebe, A., et al. (1989). Pain: Clinical manual for nursing practice, Mosby St. Louis, MO

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    This table discusses two tools which can provide a quick assessment of nutrition status: Canadian Nutrition Screening Tool and the Subjective Global Assessment

    Reference: Registered Nurses Association of Ontario (RNAO). 2016. Appendix M: Nutrition Screening and Assessment Tools. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition. Accessed July 28, 2016 http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf  pp. 138.

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    This link to the RNAO Interest Group website leads to resources and information regarding the benefits of membership and the role of interest group members in leading, promoting and influencing wound related public policy in Ontario.

    Reference: Ontario Wound Interest Group. Website http://ontwig.rnao.ca

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    PACSLAC is a tool to observe and assess both common and subtle pain behaviours. Copyright © Shannon Fuchs-Lacelle and Thomas Hadjistavropoulos. The PACSLAC may not be reproduced without permission. For permission to reproduce the PACSLAC, please contact the copyright holders (Thomas.Hadjistavropoulos@uregina.ca).

    Retrieved from http://www.geriatricpain.org/content/Assessment/Impaired/Pages/default.aspx

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    Comprehensive pain assessment tool for use in cognitively intact adults with pressure injuries. This pain assessment tool is useful for people with dementia who are unable to verbally express their pain. It focuses on behaviours and provides the ability to score pain levels.

    Reference: Interior Health. Retrieved from http://bcbpsd.ca/docs/part-1/Final%20Provincial%20PAINAD%20Scale.pdf

     

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    The following is not an exhaustive list of pain assessment tools but rather suggestions of tools identified within the systematic review; AGREE II appraised guidelines, by the expert panel or external stakeholder feedback.

    Reference: Registered Nurses 'Association of Ontario. (2016). Appendix N of Assessment and Management of Pressure Injuries for the Interprofessional Team. Toronto, Canada: Author. pp 139. http://rnao.ca/bpg/guidelines/pressure-injuries

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    The Photographic Wound Assessment Tool© (PWAT) Revised is a valid and reliable tool for assessing wound status over time, recognizing that standardized equipment and a consistent technique should be used with serial wound photography.

    Reference: Hodgkinson, Bowles H, Gordey L, Parslow N, and Houghton P. 2010. Photographic Wound Assessment Tool (PWAT) Revised. http://www.southwesthealthline.ca/healthlibrary_docs/B.9.3b.PWATInstruc.pdf

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    Gain the knowledge and skill required to manage the unique challenges inherent in the positioning of residents with varying degrees of dependency.

    Learn how to position a resident in good body alignment, taking into consideration typical scenarios that may occur in a long-term care setting and contribute to the resident’s comfort while reducing the instance of pressure ulcers and contractures.

    Retrieved from: http://rnao.ca/bpg/guidelines/resources/positioning-techniques-longterm-careselfdirected-learning-package-health-ca
     

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    This table is an overview and comparison of the strengths and weakness of wound assessment tools including the: Pressure Ulcer Scale for Healing (PUSH); Photographic Wound Assessment Tool (PWAT); and the Bates-Jensen Wound Assessment Tools.

    Reference: Registered Nurses Association of Ontario (RNAO). 2016. Appendix I: Pressure Injury Assessment Tools. In Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf

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    This webpage provides links to illustrations for each of the new pressure injury stages.

    Copyright: These illustrations can be downloaded by clicking on the links below directly to your computer at no cost, if for educational purposes. There is no cost to use these illustrations; however donations to support the work of NPUAP are graciously accepted. For profit uses of the drawings are subject to a charge, please contact Jen Bank for more information. **Use of drawings is permitted for educational purposes only.

    Reference: National pressure ulcer advisory panel (n.d.). Pressure Injury Staging Illustrations. Retrieved from http://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-staging-illustrations/

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    This document released by the Medical Advisory Secretariat contains a systematic review of pressure ulcer prevention interventions.

    Medical Advisory Secretariat. Pressure Ulcer prevention: an evidence-based analysis. Ontario Technology health Assessment Series 2009; 9(2).

    Weblink: http://www.hqontario.ca/english/providers/program/mas/tech/reviews/pdf/rev_pup_20090401.pdf

     

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    This tool identifies seven areas related to PURS assessment. A high score indicates high risk for pressure ulcer.

    Registered Nurses’ Association of Ontario. (2011) Appendix K of Risk assessment and prevention of pressure ulcers: Guideline Supplement. Toronto, Canada. P.40. Retrieved from:

    http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
     

     

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    Pressure Ulcer Scale for Healing (PUSH) Tool 3.0 was developed by the National Pressure Ulcer Advisory Panel (NPUAP) as a valid and reliable tool to assess the change in status of pressure ulcers over time.

    The link takes you to the NPUAP website where you will find the tools and information on use and copyright.

    • PUSH Tool (web version)
    • PUSH Tool (PDF version)
    • Reprint Agreement (PDF)
    • Information and Resgistration Form
    • Instructions for Using PUSH
    • Copyright Policy and Contract

    Reference: National Pressure Ulcer Advisory Committee (1998). Accessed Sept. 14, 2016. Retrieved from: http://www.npuap.org/resources/educational-and-clinical-resources/push-tool/

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    This table developed through the Residents First Initiative provides examples of clinical and organizational change strategy options in the area of pressure ulcers.
    Health Quality Ontario. (2011, February). Pressure Ulcers – Clinical and Organizational Change Concepts and Ideas.
    Retrieved from: http://www.hqontario.ca/quality-improvement/long-term-care/tools-and-resources

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    This poster outlines key steps in the development of a pressure ulcer Quality Improvement plan. The poster is intended for use as a worksheet that can support the needs of individual organizations.

    Reference: Health Quality Ontario, (2011), Pressure Ulcer Change Poster, http://www.hqontario.ca/portals/0/Documents/qi/rf-poster-pressure-ulcers-en.pdf

     

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    This internationally developed quick reference guide summarizes evidence based guidelines on pressure ulcer prevention and treatment.

    Copyright © National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. All rights reserved. Apart from any fair dealing for the purposes of private study, research or review, as permitted under the Copyright Act, no part may be reproduced or copied in any form or by any means without written permission. Requests to reproduce information can be emailed to admin@internationalguideline.com  

    Reference: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Emily Haesler (Ed.) (2014). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Cambridge Media: Osborne Park, Western Australia. Retrieved from: http://www.npuap.org/wp-content/uploads/2014/08/Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf

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    This table uses graphs, pictures and words to illustrate the impact of high, medium and low bacterial contamination/colonization on wound healing.

    Reference: Registered Nurses Association of Ontario (RNAO). 2016. Appendix J: Progression from Bacterial Balance to Bacterial Damage. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition. Accessed July 28, 2016 http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf  pp.130-133.

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    This Best Practice Guideline Supplement complements the RNAO Risk Assessment and Prevention of Pressure Ulcers BPG (2005). It provides higher levels of evidence for earlier recommendations and includes additional recommendations based on current research.
    Registred Nurses' Association of Ontario. (2011). Risk Assessment and Prevention of Pressure Ulcers BPG Supplement. Toronto, ON: Author. 

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    Define early interventions for pressure ulcer prevention, and to manage Stage I pressure ulcers. This best practice guideline assists nurses who work in diverse practice settings to identify adults who are at risk of pressure ulcers.

    This guideline focuses its recommendations on: • Practice Recommendations including assessment, planning, intervention and discharge/transfer of care • Educational Recommendations for supporting the skills required for nurses working with adults at risk for pressure ulcers • Organization & Policy Recommendations addressing the importance of a supportive practice environment as an enabling factor for providing high quality nursing care, which includes ongoing evaluation of guideline implementation. Revised: 2011 Supplement: 2005

    This best practice guideline assists RN’s and RPN’s to identify adults who are at risk for pressure ulcers and provides direction to nurses in defining early interventions.

    Registered Nurses’ Association of Ontario (2013). Risk Assessment and Prevention of Pressure Ulcers Best Practice Guideline (rev.2011) Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers
     

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    The following is one method of how to perform a seating assessment for people with pressure injuries. This is not an exhaustive list but rather an example of a seating assessment identified within the systematic review, AGREE II appraised guidelines, by the expert panel or external stakeholder feedback. The term “pressure ulcer” used in this appendix, refers to “pressure injury.”

    Reference: Registered Nurses 'Association of Ontario. (2016). Appendix O of Assessment and Management of Pressure Injuries for the Interprofessional Team. Toronto, Canada: Author. pp 140-141.

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    Skin and Wound Refresher for LTC with associated powerpoint slide hand-out. This three part YouTube webinar series is a refresher course for registered staff and DOC in LTC. The three part series can be viewed all together, or broken up into three parts. It also includes one additional video of the Q&A that were asked of the presenters following the presentations. Topics covered in the webinars include

    • Assessment of Skin
    • Pressure Management and
    • Pressure Ulcers

    Web Address or Source: https://www.youtube.com/playlist?list=PL2DgRL1VXwQJ44YGeF0HX0_enTKagMU3w and the presentation that goes with http://www.usask.ca/nursing/cedn/docs/SkinCareSkinTearsandPressureUlcers.pdf  Fentiman, P. (Continuing education and development for nurses). (2015, November 19). Skin and Wound Care Refresher for LTC. Retrieved from https://www.youtube.com/playlist?list=PL2DgRL1VXwQJ44YGeF0HX0_enTKagMU3w

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    Skin and Wound Refresher for LTC with associated powerpoint slide hand-out. This three part YouTube webinar series is a refresher course for registered staff and DOC in LTC. The three part series can be viewed all together, or broken up into three parts. It also includes one additional video of the Q&A that were asked of the presenters following the presentations. Topics covered in the webinars include

    • Assessment of Skin
    • Pressure Management and
    • Pressure Ulcers

    Web Address or Source: https://www.youtube.com/playlist?list=PL2DgRL1VXwQJ44YGeF0HX0_enTKagMU3w  and the presentation that goes with http://www.usask.ca/nursing/cedn/docs/SkinCareSkinTearsandPressureUlcers.pdf Fentiman, P. (Continuing education and development for nurses). (2015, November 19). Skin and Wound Care Refresher for LTC. Retrieved from https://www.youtube.com/playlist?list=PL2DgRL1VXwQJ44YGeF0HX0_enTKagMU3w

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    The following is one method of how to select the appropriate support surface for people with pressure injuries. This is not an exhaustive list but rather an example of a tool for support surface selection identified within the systematic review, AGREE II appraised guidelines, by the expert panel or external stakeholder feedback. The term “pressure ulcer” used in this appendix, refers to “pressure injury.”

    Reference: Registered Nurses 'Association of Ontario. (2016). Appendix Q of Assessment and Management of Pressure Injuries for the Interprofessional Team. Toronto, Canada: Author. pp 143-146.

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    This appendix describes the Levine technique, a method of obtaining a semi-quantitative wound culture swab in order to guide the use of appropriate anti-infective agents

    Reference: Registered Nurses Association of Ontario (RNAO). 2016. Appendix L: Swabbing Technique. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition. Accessed July 28, 2016 http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf  pp. 137.

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    Pressure ulcers or bedsores are caused by constant pressure that damages the skin and underlying tissue. They can develop in a very short time period and take longer to heal. They may have a huge impact on your every day life, as normal activities can be restricted while the ulcer heals.

    If you spend long periods of time in a bed, chair or wheelchair and have lost your feeling in your lower body, you maybe at increased risk of getting pressure ulcers. In most cases, pressure ulcers can be prevented.

    Retrieved from: http://rnao.ca/bpg/fact-sheets/taking-pressure-preventing-pressure-ulcers
     

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    Unidimensional pain assessment tool for use in adults with pressure injuries

    Web Address: http://www.partnersagainstpain.com/printouts/A7012AS1.pdf

    Reference: Stratton Hill C. Guidelines for Treatment of Cancer Pain: The Pocket Edition of the Final Report of the Texas Cancer Council's Workgroup on Pain Control in Cancer Patients, pages 65. Copyright - 2003, 2005 by the Texas Cancer Council. Used with permission. www.texascancercouncil.org

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    This two-page card provides a risk assessment scoring system that can be used to determine the resident's risk for pressure ulcers. The reverse side provides guidance on nursing care, types of preventative aids associated with the three levels of risk status, wound assessment and dressings.

    One side illustrates the risk assessment scoring system click here One side illustrates the risk assessment scoring system click here http://www.judy-waterlow.co.uk/downloads/Waterlow%20Score%20Card-front.pdf  

    The reverse side provides guidance on nursing care, types of preventative aids associated with the three levels of risk status, wound assessment and dressings click here http://www.judy-waterlow.co.uk/downloads/Waterlow%20Score%20Card-back.pdf

    The separate sides of the card may be printed off/downloaded for Free http://www.judy-waterlow.co.uk/the-waterlow-score-card.htm  

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    Unidimensional pain assessment tool for use in adults with pressure injuries

    Web Address: http://www.partnersagainstpain.com/printouts/A7012AS6b.pdf

    Reference: . 81-82. Registered Nurses’ Association of Ontario (2013). Assessment and Management of Pain Third Edition. Toronto, ON: Author. Appendix E p. 82-83 http://rnao.ca/bpg/guidelines/assessment-and-management-pain