Introducing the Early Identification Strategies Toolbox developed by the Pressure Ulcer Prevention Advisory Board.

Supported by an educational grant from BBI

Pressure ulcers (also known as as decubitus, bed sores or pressure injury1) remain a challenge for both the providers and users (patients, clients) of health care services.

In many cases, with good preventative care, up to 50% of the most serious pressure ulcers could be avoided.2 Traditional models of risk assessment, such as the use of numerical scoring systems, are cumbersome and require knowledge of their use and are not always aligned to the care environment or the specific vulnerability of the population.3,4

These wounds are frequently painful, reduce an individual’s quality of life and wellbeing, and are associated with serious complications such as infection; in extreme cases a pressure ulcer may lead to death. For health service providers, these injuries may significantly increase costs,5 not least due to extended inpatient stay, access to outpatient and home care services, and use of resources.

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Early Identification of Risk

The identification of increased risk is only the starting point of the process. Once risk has been identified, an appropriate plan of care should be put into place before the signs of Category I damage are visible at the skin surface
(non-blanching erythema).1

In order to standardise both the early identification of risk and early intervention, many organisations are now developing pathways for pressure ulcer prevention. These protocols are typically based upon existing national or international guidelines, for example NICE6 (UK) or NPUAP, EPUAP, PPPIA1 (International).

To build on these guidelines and support clinical staff in this process, the Pressure Ulcer Prevention Advisory Board have developed an algorithm using a simple framework that can be used alongside local policies and form the basis of local preventative care pathways.

The Early Identification Strategies Toolbox

Download the booklet ‘Implementing Early Identification of Increased Risk of Pressure Ulcer in Care Pathways’

Chapters include:
Early Identification of Pressure Ulcer Risk and Early Intervention
Escalation Strategies for Early Identification of Increased Risk of Pressure Ulcers
Implementation Based Practice: What Does Good Look Like

Algorithm – Pathway to Support Early Identification of Increased Risk of Pressure Ulcers

The Early Identification Strategies Toolbox

fig1. Discharge Pathway

fig2. Discharge Pathway

fig4. ASSKING Bundle

fig5. Pressure Ulcer Prevention Standards England, Scotland & Wales

fig7. Adapted from BEST SHOT Skin Assessment

fig8. Driver Diagram

fig9. Stakeholder Groups

fig10. Measurable Outcomes

Pressure Ulcer Prevention Advisory Board


1. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014.
2. Downie F, Guy H, Gilroy P et al. Are 95% of hospital-acquired pressure ulcers avoidable? Wounds UK. 2013; 9(3):16-22
3. Guy H (2012) Pressure ulcer risk assessment. Nursing Times 108(4): 16-20
4. Healthcare Improvement Scotland (2011) SSKIN Care bundle.
5. Guest JF, Ayoub N, McIlwraith T et al. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open 2015;5: e009283. doi:10.1136/bmjopen-2015-009283
6. National Institute of Health and Care Excellence. Pressure Ulcers: Prevention and Management of Pressure Ulcers NICE Clinical Guideline 179. 2014. Accessed October 2018