Resources: Pressure Ulcer: risk prevention, assessment and management 

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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Best Practices/Standards
ResourceLink
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).
En haut de la page principale, il y a un hyperlien pour la version française de ce document.
 

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.

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Risk Assessment Tools
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Assessment Tools
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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.

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Planning & Implementation Tools
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RNAO Toolkit: Implementation of Best Practice Guidelines, Second Edition

This Toolkit was designed to assist health care settings in maximizing the potential of Clinical Practice Guidelines through systematic and well-planned implementation. It was also designed to accompany the Nursing Best Practice Guidelines (NBPGs) developed by the Registered Nurses' Association of Ontario (RNAO) in order to facilitate their implementation.

RNAO's Best Practice Guideline Implementation: Project Plan

This project plan is intended to be used as an example in organizations wishing to develop an implementation strategy of their own. The project plan demonstrates how and when implementation of the RNAO BPG will occur, by showing the major milestones of the project, and the activities and resources required to meet these goals.

RNAO's Sustainability of Best Practice Guideline Implementation

Examine sustainability of guideline implementation through strategies associated with sustainability.
Using the Ottawa Model,learn a framework for sustainability and investigate considerations for evaluating success.

RNAO Best Practice Champion Network

RNAO provides free training and networking opportunities to nurture skills in implementing best practice guidelines for individuals and teams.

RNAO's ABCs for BPGs

A workbook designed to introduce nurses and other interprofessional team members in Long-Term Care to the basics of best practice guideline implementation.

RNAO Trousse: Mise en oeuvre des lignes directrices sur les pratiques exemplaires, Deuxième édition

Mise en place des lignes directrices pour la pratique clinique.

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Quality Improvement Tools
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Health Quality Ontario (HQO) | Qualité des services de santé Ontario

This link provides information and resources about quality improvement and related initiatives in Ontario.
En haut de la page principale, il y a un hyperlien pour la version française de ce document.

Health Quality Ontario: Quality Improvement Guide for Long-Term Care (English)

This document provides information and tips on using various quality improvement tools.

Health Quality Ontario (HQO) - Residents First Roadmap to Preventing Pressure Ulcers

This link accesses a 20-page road map to preventing pressure ulcers.
En haut de la page principale il y a un hyperlien pour la version française de ce document.

Health Quality Ontario (HQO) Residents’ First Quality Improvement Resources | Priorité aux Résidents Favorise la Qualité dans les Foyers de Soins de Longue Durée en Ontario

This site provides access to templates and resources for using quality improvement tools; just scroll down to the section on quality improvement resources.
En haut de la page principale il y a un hyperlien pour la version française de ce document.

Pressure Ulcer Awareness & Prevention Collaborative: Change Package

This resource provides practical examples for organizational change, working to prevent pressure ulcers.  Source: Ontario Association of Not-for-Profit Homes and Services for Seniors.  October, 2008.

 

Required Organizational Practices Handbook

This resource from Accreditation Canada – Agreement Canada defines a required organizational practice (ROP) as essential practice that enhances client safety and minimizes risk.

Health Quality Ontario: Residents First Tools and Resources, Change Packages and External Resources

This website provides links to downloadable information to help with project accessibility and efficiency through the use of quality improvement tools.

Institute for Healthcare Improvement (IHI): Model for Improvement

Developed by Associates in Process Improvement. A simple tool that offers a wide range of resources and teaching tools to help health-care professionals lead effective improvement efforts, enhance clinical outcomes, and reduce risks

PDSA Worksheet

The Plan-Do-Study-Act (PDSA) or Deming Cycle worksheet is a quality improvement tool that is an excellent method to first identify the possible ideas for improvement and then test each of them out thoroughly. This is done in a rapid succession of small tests, each test trying out different variations or combinations of ideas.

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Additional Implementation Resources
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National Pressure Ulcer Advisory Panel (NPUAP) - Quick Reference Guides for Prevention of Pressure Ulcers

 This quick reference guide summarizes evidence based guidelines on pressure ulcer prevention.

The Payne Martin Skin Tear Tool

This tool classifies skin tears.

RNAO Support Surface Selection Tool

This document describes different support surfaces through the use of a flow chart.

RNAO Wound Cultures : Swabbing Techniques

This document describes how to swab a wound for infection.

RNAO Cultures de Plaie: Techniques d’écouvillonnage

Annexe L - Ce document decrit comment proceder a un prelevement par ecouvillon d’une plaie infectee. De Évaluation et traitement des lésions de pression de stades 1 à 4, p 100.

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Policies and Procedures
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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

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Care Planning
ResourceLink
RNAO Individual Braden Subscale Intervention Checklist

 This tool provides a list of interventions, based on the Braden scale that can help to individualize your pressure ulcer care plan.

RNAO Response to Pressure Ulcer Risk Assessment

 This tool links the results of a client risk assessment related to pressure ulcers to the identification and planning of appropriate interventions

RNAO's Key Factors in Deciding Method of Debridement

This resource outlines the key factors in deciding the method of debridement (Appendix L).   Includes definition and examples of debridement (pages 36-37).  Taken from RNAO's Assessment and Management of Stage I to IV Pressure Ulcers Best Practice Guideline.

RNAO Clinical Signs and Symptoms of Wound Infection

 This tool describes the clinical signs of wound infection.

 

RNAO's Positioning and Support Surfaces – A Checklist

This checklist is useful when assessing the appropriate positioning and support surfaces for residents. Page 87 from RNAO's Assessment and Management of Stage I to IV Pressure Ulcers Best Practice Guideline.

RNAO's Support Surface Considerations

This document provides information on pressure management surfaces and tips for choosing appropriate surfaces. It is recommended that retailers are contacted for further information and troubleshooting for an existing support surface.  Page 86 of RNAO's Assessment and Management of Stage I to IV Pressure Ulcers Best Practice Guideline.

RNAO's Wound Care Dressings

These documents describe commonly used agents to prevent infection and treat pressure ulcers.  Page 102-103 from RNAO's Assessment and Management of Stage I to IV Pressure Ulcers Best Practice Guideline.

RNAO Positionnement et support – Liste de vérification

Annexe I: Ce document offre des conseils sur le positionnement des clients. De Évaluation et traitement des lésions de pression de stades 1 à 4, page 89.

RNAO Produits de Soin des Plaies

Annexe J: Ces documents décrivent des agents qui sont souvent utilises pour la prévention de l’infection et le traitement des escarres de décubitus.

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Education Resources
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Self Learning and PowerPoint Presentations
Charts
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.

Videos
Websites
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.

Education Resources
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.

Other Resources
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).

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Evaluation
ResourceLink
RNAO Wound/Wound Care Discharge Transfer Tool

 This tool provides information about the risk and wound treatment of pressure ulcers when a client is discharged from an organization or transferred to an organization.

RNAO's Potential Indicators for Evaluation of the Implementation of Clinical Practice Guidelines

This document helps to identify evaluation objectives.  Source: RNAO Toolkit Implementation of Clinical Practice Guidelines.  March 2002, page 63.

RNAO Evaluating Your Success

From RNAO’s Toolkit: Implementation of Clinical Practice Guidelines, Chapter 5, pages 57-64.

Ontario Injury Prevention Resource Centre's Toolkit of Evaluation Methods & Measures

This website provides access to a toolkit of evaluation methods and measures.

The Evaluation Center – Western Michigan University

This contains checklists and tools for planning your evaluation.

Public Health Agency of Canada - A Guide to Project Evaluation: A participatory approach | Guide d'évaluation de projet: Une démarche participative

This evaluation guide provides an easy-to-use comprehensive framework for project evaluation. 
En haut de la page principale, il y a un hyperlien pour la version française de ce document. 

RNAO Indicateurs possibles pour l’évaluation de la mise en place des Lignes directrices pour la pratique clinique (LDPC)

Ce document permet d’identifier les objectifs de l’évaluation.  Source de L’Association des infirmières et infirmiers autorisés de l’Ontario: Trousse sur la marche à suivre. Mars 2002, page 65.

RNAO Évaluation de votre succès

Faits saillants chapitre entier et une partie de boîte à outils liant qui est déjà mentionné dans la section de planification. Source de L’Association des infirmières et infirmiers autorisés de l’Ontario: Trousse sur la marche à suivre. Mars 2002, page 59-66.

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Recommended Readings/References
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Other RNAO resources related to pressure ulcer

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