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.
Get started
Registered Nurses’ Association of Ontario (2024). Pressure injury management: Risk assessment, prevention and treatment, Fourth Edition. Toronto, ON: Registered Nurses’ Association of Ontario.
Recommendations
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 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 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 3.0: The expert panel suggests that nurses and health providers implement preventative care bundles for persons at risk of pressure injuries.
An earlier version of this guideline included a systematic review by Wang et al. (2024) to support recommendation 3.0. In 2025, this systematic review was retracted by the journal. The RNAO BPG team conducted a targeted search of the literature and identified a systematic review by Lin et al. (2020) which now informs recommendation 3.0. For more information, please contact the RNAO BPG development team.
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 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.
