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Early Identification Strategies Toolbox

Implementing Early Identification of Increased
Risk of Pressure Injury/Ulcer (PI/PU) in Care

“Early identification of PI/PU risk in a timely manner
provides a mechanism to intervene with effective
prevention strategies.”

Pressure Injury/Ulcer Prevention Advisory Board, 2019


The Early Identification Strategies Toolbox

Developed by the Pressure Injury/Ulcer Prevention Advisory Board
Supported by an educational grant from Bruin Biometrics

Pressure Injuries/Ulcers (PI/PU), also known as decubitus or bed sores,1 remain a challenge for both the providers and users (patients, clients) of health care services.

In many cases, with good preventative care, a good proportion of the most serious PI/PUs 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 PI/PU 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.

Implementing early identification of increased risk of pressure ulcer in care pathways

Chapters include:

Early Identification of PI/PU Risk and Early Intervention

Escalation Strategies for Early Identification of Increased Risk of PI/PUs

Implementation Based Practice: What Does Good Look Like

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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 standardize both the early identification of risk and early intervention, many organizations are now developing pathways for PI/PU prevention. These protocols are typically based upon existing national or international guidelines, for example NICE6 (UK) or EPUAP, NPIAP, PPPIA1 (International).

To build on these guidelines and support clinical staff in this process, the PI/PU 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.


Pressure Injury/Ulcer Prevention
Advisory Board

Professor Karen Ousey

Director, Institute of Skin Integrity and
Infection Prevention, University of

Alison Schofield

Lead Tissue Viability Nurse for Pressure
Ulcer Prevention, North Lincolnshire and
Goole NHS Foundation Trust

Jacqui Fletcher

Independent Healthcare Consultant,
Jacqui Fletcher Limited

Mark Collier

Independent Healthcare Consultant and
Associate Lecturer – Tissue Viability

Jeanette Milne

Clinical Lead, Tissue Viability,
Northumbria Healthcare NHS Foundation

Louise O’Connor

Lead Nurse, Tissue Viability, Manchester
University Hospitals NHS Foundation

Glenn Smith

Nurse Prescriber, St Helens Medical
Centre, Isle of Wight

Facilitated by

Richard H Shorney

from Real Healthcare Solutions Ltd

1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. Emily Hasler (Ed.). EPUAP/NPIAP/PPPIA
2. Downie F., et al. (2013). Are 95% of hospital-acquired pressure ulcers avoidable? Wounds UK; 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 J.F., et al. (2015). Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open;5: e009283. doi:10.1136/bmjopen-2015-009283
6. National Institute of Health and Care Excellence. (2014). Pressure Ulcers: Prevention and Management of Pressure Ulcers NICE Clinical Guideline 179 Accessed October 2018

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