Purpose and scope
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 .
This BPG provides evidence-based recommendations for nurses, and the interprofessional team, and persons and their caregivers across all care settings and sectors. The recommendations address the prevention of pressure injuries for at-risk people, and the assessment and management of those living with pressure injuries.
Overall, the scope includes:
- all domains of nursing practice;
- all health-care settings and sectors;
- all populations across the lifespan (e.g., pediatric, adult and older adult), including their caregiver/chosen family; and all types of pressure injuries, including those medical device-related.
Registered Nurses’ Association of Ontario (2024). Pressure injury management: Risk assessment, prevention and treatment, Fourth Edition. Toronto, ON: Registered Nurses’ Association of Ontario.
Recommendations
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Pressure injury management: Risk assessment, prevention and treatment.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
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.
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.
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.
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.
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.
Recommendation question #1: Should the use of health technologies be recommended or not for early detection and assessment of pressure injuries?
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.
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.
Recommendation question #2: Should a specific repositioning frequency be recommended over another frequency for persons with pressure injuries or those at risk of developing them?
Recommendation 2.0: The expert panel suggests that nurses and health providers reposition persons at risk of pressure injuries every 2-4 hours.
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; and
- comfort.
Recommendation question #6: Should the use of powered support surfaces (active or reactive) for the prevention and management of pressure injuries be recommended or not?
No recommendation was made. The expert panel determined that current evidence was insufficient to balance the benefits and harms of powered support surfaces compared to non-powered support surfaces. Choice of support surface should be individualized and in line with good practice statement 6.0.
Recommendation question #3 Should preventative care bundles be recommended or not for the prevention of pressure injuries?
Recommendation 3.0: The expert panel suggests that nurses and health providers implement preventative care bundles for persons at risk of pressure injuries.
Recommendation question #4: Should the use of prophylactic dressings be recommended or not for the prevention of pressure injuries?
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.
Recommendation question #5: Should the use of health technologies be recommended or not for the treatment of pressure injuries?
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.
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.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.
