The following resource is designed to assist Long-Term Care (LTC) homes with the implementation of the Risk Assessment and Prevention of Pressure Ulcers and Assessment and Management of Stage I to IV Pressure Ulcers Best Practice Guidelines. Documents found in this resource are evidence-based, but it is not a program plan. Each LTC home is unique and each home is in various stages of guideline implementation. LTC homes are advised to use the resource at their discretion. For those resources that have copyright notations, it is recommended that LTC homes obtain permission from the primary author prior to implementing them within their setting. The Toolkit is a dynamic resource, and is being updated and revised on a regular basis by the LTC Best Practices Initiative team. Visit this site often to see what's new!
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RNAO Risk Assessment and Prevention of Pressure Ulcers Best Practice Guideline
The Registered Nurses' Association of Ontario (RNAO) best practice guideline provides evidence based recommendations related to risk assessment and prevention of pressure ulcers (originally published in 2002; added supplement in 2005; guideline revised in 2011). Guideline is also available in French, Spanish and Italian.
RNAO Risk Assessment and Prevention of Pressure Ulcers BPG Supplement
This supplemental guideline provides updates to the evidence-based recommendations found in the Risk Assessment & Prevention of Pressure Ulcers best practice guideline.
RNAO Risk Assessment and Prevention of Pressure Ulcers PDA Guideline
The RNAO guideline recommendations in Personal Digital Assistant (PDA) format.
RNAO Assessment and Management of Stage I to IV Pressure Ulcers Best Practice Guideline
This guideline provides evidence-based recommendations related to the assessment and management of all stages of pressure ulcers. (Originally published in 2002, revised in 2007). Guideline is also available in French, Spanish and Italian.
RNAO Assessment and Management of Stage I to IV Pressure Ulcers PDA Guideline
The RNAO guideline recommendations in Personal Digital Assistant (PDA) format.
Gap Analysis Worksheet on Risk Assessment and Prevention of Pressure Ulcers
Updated February 2014.
Gap Analysis Worksheet on Assessment and Management of Stage I to IV Pressure Ulcers
Updated February 2014.
Ministry of Ontario, LTC Homes Act 2007, Ontario Regulation 79/10 | Loi de 2007 sur les Foyers de Soins de Longue Durée, Règlement de l’Ontario 79/10
This link provides access to the legislation that outlines standards that LTC homes must adhere to – of particular focus is section 48 (required programs) and section 50 (skin and wound care).
College of Nurses of Ontario's Infection Prevention and Control
This CNO practice standard reflects infection prevention and control practices for registered staff. Website: www.cno.org.
RNAO Évaluation du risque et prevention des lésions de pression
Cette directive donne des preuves qui sont fondées sur des données probantes pour soutenir l’application des recommandations dans une organisation.
RNAO Évaluation du risque et prévention des lésions de pression : guide pour assistant électronique de poche
La directive se retrouve dans un format ANP (assistant numérique personnel).
RNAO Évaluation et traitement des lésions de pression de stades 1 à 4: guide pour assistant électronique de poche
La directive se retrouve dans un format ANP (assistant numerique personnel).
La prévention des infections
Source Ordre des infirmières et infirmiers de l’Ontario: Norme d’exercice, 2009. http://www.cno.org.
The Braden Scale for Predicting Pressure Ulcers
The Braden scale assesses pressure sore risk in six areas to determine a numerical score to indicate pressure ulcer risk. Source: Policy and Procedure - Skin Care and Pressure Ulcer Management. Developed by the Toronto Best Practice Implementation Steering Committee. March 2006, pg. 13-14.
Waterlow Pressure Ulcer Prevention/Treatment Chart
This two page document identifies eight areas to determine pressure ulcer risk, and suggestions for related nursing care. Further information on the Waterlow Pressure Ulcer Risk Assessment Chart can be found at http://www.judy-waterlow.co.uk.
RNAO's Bates-Jensen Wound Assessment Tool (BWAT)
BWAT is a validated pressure ulcer assessment tool measuring wound status on a continuum. Obtained with permission. Appendix K of RNAO's Assessment & Management of Stage I to IV Pressure Ulcers BPG, page 92-93.
RNAO Pressure Ulcer Scale for Healing (PUSH) documentation wound assessment tool
The PUSH tool is used to determine improvements and/or deterioration in pressure ulcers over time. Page 94-95 of Assessment & Management of Stage I to IV Pressure Ulcers BPG.
RNAO Staging of Wounds
A brief description of the different stages of pressure ulcers. Page 88 of RNAO's Assessment and Management of Stage I to IV Pressure Ulcers Best Practice Guideline.
RNAO Wound Measurement
This illustrative tool describes how to measure length, width and tunnelling of pressure ulcers.
RNAO Measure Assessment Guide
This tool uses the acronym ‘measure’ to help clinicians with principles of wound assessment.
RNAO's Tools for Assessment of Pain
This document provides six different tools for assessing pain. Appendix E of RNAO's Assessment and Management of Stage I to IV Pressure Ulcers Best Practice Guideline (page 83-84).
RNAO Mini Nutritional Assessment
This tool, a mini nutritional assessment (MNA), screens and assesses nutrition by giving a malnutrition score indicating a need for further assessment. Page 82 of RNAO's Assessment and Management of Stage I to IV Pressure Ulcers Best Practice Guideline.
RAI-MDS & P.I.E.C.E.S.(TM) job aid – outcome scales
This document demonstrates the links between P.I.E.C.E.S.TM and RAI-MDS. For more information on P.I.E.C.E.S.TM, go to www.piecescanada.com.
RNAO InterRAI Pressure Ulcer Risk Scale
This tool identifies seven areas related to PURS assessment. A high score indicates high risk for pressure ulcer. Appendix K of Risk Assessment and Prevention of Pressure Ulcers Supplement, page 40.
RNAO Outil de Mesure du Risque de Lésion de Pression de Braden
Annexe B -l’échelle de Braden évalue le risque de développer des escarres de décubitus dans six domaines afin de déterminer un score numérique qui indiquera le niveau de risque de développer une plaie. De Évaluation et traitement des lésions de pression de stades 1 à 4, p. 76-77.
RNAO Stades des plaies
Annexe C - Une brève description des différents stades des escarres de décubitus.
RNAO Mesure des Plaies
Annexe D - Un guide a la description de l’escarre, qu’aide dans l’organisation, l’évaluation et le traitement.
RNAO Outils d’Évaluation de la Douleur
Annexe G - ce document fournit des six outils différents pour évaluer la douleur. De Évaluation et traitement des lésions de pression de stades 1 à 4, p. 85.
RNAO Outil de l’évaluation de l’apport alimentaire
Annexe F - Cet outil, une évaluation condensée de l’apport alimentaire, dépiste et évalue la nutrition et donnant un score de malnutrition et indique la nécessiter d’une évaluation plus approfondi.
OANHSS Skin and Wound Care Program - Policy, Procedures and Training Package
This document contains sample program objectives, policy, procedures and staff training materials and tools that meet the minimum requirements of the LTCHA and regulation. Obtained with permission. Source: Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS). Released: November 26, 2010. Web: www.oanhss.org.
Policy and Procedure: Skin Care and Pressure Ulcer Management
An example of a detailed policy and procedure for skin care and pressure ulcer management in residents. Developed by: Toronto Best Practice in LTC Initiative, March 2006.
Policy and Procedure: Hydration Management
An example of a detailed policy and procedure for preventing dehydration in long term care residents. Developed by: Toronto Best Practice in LTC Initiative, September 2007.
Policy and Procedures on Pain Assessment and Management
An example of a detailed policy and procedure on pain assessment and management. Developed by: Toronto and Central East Best Practice in LTC Initiative, December 2006
|Self Learning and PowerPoint Presentations|
|Fact Sheets / Pamphlets / Pocket Cards / Logos|
RNAO Fact Sheet - Taking the Pressure Off: Preventing Pressure Ulcers
This is a fact sheet highlighting tips for pressure ulcer best practices for the clients/patients/residents. This informative fact sheet supplements the information found in the RNAO Nursing Best Practice Guidelines on Risk Assessment and Prevention of Pressure Ulcers and Assessment and Management of Stage I to IV Pressure Ulcers.
Institute for Healthcare Improvement: What You Need to Know about Pressure Sores
A fact sheet for families and clients abut pressure ulcer risk
BP Blogger “The Wound Issue” - October 2009
From the Regional Geriatric Program (RGPC), a 2-page document outlining myths and facts about wound issues.
BP Blogger “The Skin Care Issue” - May 2007
From the Regional Geriatric Program (RGPC) a 2-page document outlining myths and facts around skin care issues.
BP Blogger "The Fluids Issue" - June 2007
A succinct, 2-page newsletter that covers myths and facts about dehydration in LTC residents. Developed by the Best Practice in LTC Initiative Central South and The Long Term Care Resource Centre Hamilton
RNAO Soulager la pression: Prévention des lésions de pression
Une fiche de renseignements pour la sensibilisation en matière de santé de la part des infirmières et des infirmières.
Canadian Association of Wound Care (CAWC)
A not-for-profit organization dedicated to the advancement of wound care in Canada.
National Pressure Ulcer Advisory Panel (NPUAP)
The NPUAP serves as the authoritative voice for improved patient outcomes in pressure ulcer prevention and treatment through public policy, education, and research.
Pressure Ulcer Awareness Program (PUAP)
This link provides information on the national effort to reduce pressure ulcers.
Seniors Health Knowledge Network (SHKN)
A division of Ontario’s Health Care Information Exchange providing evidence-based information through a network of networks on seniors’ health.
Wound Care Community of Practice
This link provides information about the Wound Care Community of Practice through the Seniors Health Knowledge Network.
The Canadian Association for Enterostomal Therapy
This link provides information and resources related to wounds, ostomy, and continence care.
American Geriatric Society
This American based web site provides information about pressure ulcers.
RNAO's Educational Program: Assessment and Management of Pressure Ulcers
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.
RNAO Ontario Wound Interest Group
A group of interdisciplinary health-care professionals, who lead, promote, and influence wound prevention and treatment. Website: http://ontwig.rnao.ca/
RNAO's Best Practices in Wound Care Institute: Minding the Gap
This RNAO week-long learning institute provides opportunities to learn about best practices in wound care through interactive dialogue with wound care experts, case studies, demonstrations and hands-on application labs.
Regional Geriatric Program (RGP) online teaching resources
A collection of online teaching resources for specialized geriatric services including pressure ulcers and wound care. Also a valuable learning library and link to the GiiC portal (http://rgps.on.ca/giic/index.en.html).
Other RNAO resources related to pressure ulcer
Click directly on each resource below: