Quality statement 1: Pressure ulcer risk assessment in hospitals and care homes with nursing

Quality statement

People admitted to hospital or a care home with nursing have a pressure ulcer risk assessment within 6 hours of admission.

Rationale

Healthcare professionals can identify people who are at risk of developing pressure ulcers by carrying out a pressure ulcer risk assessment. By doing this within 6 hours of when a person is admitted to hospital or a care home with nursing, those at risk or high risk of developing pressure ulcers can be identified without delay. Acting on the results of the risk assessments allows healthcare professionals to offer preventative treatment to people at risk, helping to reduce the number of people developing a pressure ulcer and ensuring patient safety.

Quality measures

Structure

a) Evidence of local arrangements to ensure that healthcare professionals in hospitals and care homes with nursing know how to carry out pressure ulcer risk assessments.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that people admitted to hospital or a care home with nursing have a pressure ulcer risk assessment within 6 hours of admission.

Data source: Local data collection.

Process

a) Proportion of new inpatient hospital admissions that have a pressure ulcer risk assessment carried out within 6 hours of admission.

Numerator – the number in the denominator that have a pressure ulcer risk assessment carried out within 6 hours of admission.

Denominator – the number of new inpatient hospital admissions.

Data source: Local data collection.

b) Proportion of new residential admissions to care homes with nursing that have a pressure ulcer risk assessment carried out within 6 hours of admission.

Numerator – the number in the denominator that have a pressure ulcer risk assessment carried out within 6 hours of admission.

Denominator – the number of new residential admissions to care homes with nursing.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (hospitals and care homes with nursing) ensure that systems are in place for healthcare professionals to be trained in assessing pressure ulcer risk, and that they carry out and document a pressure ulcer risk assessment within 6 hours of a person being admitted to hospital or a care home with nursing.

Healthcare professionals ensure that they know how to assess a person's pressure ulcer risk, and that they carry out and document a pressure ulcer risk assessment within 6 hours of a person being admitted to hospital or a care home with nursing.

Commissioners (clinical commissioning groups) should specify that a pressure ulcer risk assessment is carried out and documented within 6 hours of admission for all people admitted to hospital or a care home with nursing.

What the quality statement means for patients, service users and carers

People admitted to hospital or a care home with nursing have their risk of developing a pressure ulcer assessed by a healthcare professional within 6 hours of being admitted.

Source guidance

Definitions of terms used in this quality statement

Care home with nursing

The provision of 24‑hour accommodation together with nursing care. This does not include residential care homes with non‑nursing care.

Pressure ulcer risk assessment

An assessment of pressure ulcer risk should be based on clinical judgement and/or the use of a validated scale such as the Braden scale, the Waterlow scale or the Norton risk‑assessment scale for adults and the Braden Q scale for children.

[Pressure ulcers (NICE guideline CG179) recommendations 1.1.3 and 1.2.2]

Risk of developing pressure ulcers

People considered to be at risk of developing a pressure ulcer are those who, after assessment using clinical judgement and/or a validated risk assessment tool, are considered to be at risk of developing a pressure ulcer. Risk factors include:

  • significantly limited mobility (for example, people with a spinal cord injury)

  • significant loss of sensation

  • a previous or current pressure ulcer

  • malnutrition

  • the inability to reposition themselves

  • significant cognitive impairment.

[Pressure ulcers (NICE guideline CG179) recommendations 1.1.2 and 1.2.1]

High risk of developing pressure ulcers

People considered to be at high risk of developing a pressure ulcer will usually have multiple risk factors identified during risk assessment with or without a validated risk assessment tool. Adults with a history of pressure ulcers or a current pressure ulcer are also considered to be at high risk.

[Pressure ulcers (NICE guideline CG179)]

Equality and diversity considerations

The validated scale to assess the risk of pressure ulcers should be suitable for the person being assessed. For example, when assessing children it is important to use a scale such as the Braden Q scale, which is suitable for this age group.