Quality statement 2: Pressure ulcer risk assessment by community nursing services

Quality statement

People with a risk factor for developing pressure ulcers who are referred to community nursing services have a pressure ulcer risk assessment at the first face‑to‑face visit.

Rationale

People in community care settings who have 1 or more risk factors for pressure ulcers and have been referred to community nursing services should have a pressure ulcer risk assessment to help identify the need for preventative action. Risk factors include limited mobility, loss of sensation, previous or current pressure ulcers, malnutrition and cognitive impairment. It is important to carry out the pressure ulcer risk assessment at the person's first face‑to‑face visit with community nursing services to ensure patient safety.

Quality measures

Structure

a) Evidence of local arrangements to ensure that healthcare professionals from community nursing services know how to perform pressure ulcer risk assessments.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that people with 1 or more risk factors for pressure ulcers referred to community nursing services have a pressure ulcer risk assessment at the first face‑to‑face visit.

Data source: Local data collection.

Process

Proportion of referrals to community nursing services for people with 1 or more risk factors for pressure ulcers in which a pressure ulcer risk assessment is carried out at the first face‑to‑face visit.

Numerator – the number in the denominator in which a pressure ulcer risk assessment is carried out at the first face‑to‑face visit.

Denominator – the number of referrals to community nursing services for people with 1 or more risk factors for pressure ulcers.

Data source: Local data collection.

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

Service providers (community care) ensure that systems are in place for healthcare professionals from community nursing services to be trained in assessing pressure ulcer risk and that, if a person has 1 or more risk factors, they carry out a pressure ulcer risk assessment at the first face‑to‑face visit.

Healthcare professionals from community nursing services ensure that they know how to assess a person's pressure ulcer risk and that, if a person has 1 or more risk factors, they carry out a pressure ulcer risk assessment at the first face‑to‑face visit.

Commissioners (clinical commissioning groups) should specify that community nursing services carry out a pressure ulcer risk assessment at the first face‑to‑face visit for all people with 1 or more risk factors for pressure ulcers that are referred to them.

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

People referred to community nursing services who have 1 or more risk factors for pressure ulcers have their risk of developing a pressure ulcer assessed at the first face‑to‑face visit.

Source guidance

  • Pressure ulcers (2014) NICE guideline CG179, recommendations 1.1.2 and 1.2.1 (key priority for implementation)

Definitions of terms used in this quality statement

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]

Equality and diversity considerations

The validated scale to assess the risk of pressure ulcers must 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.