Quality statement 3: Pressure ulcer risk reassessment

Quality statement

People have their risk of developing pressure ulcers reassessed after a surgical or interventional procedure, or after a change in their care environment following a transfer.

Rationale

Pressure ulcer risk status is not constant and is likely to change during the course of care. A pressure ulcer risk assessment should be repeated if there is a change in a person's clinical status. However, changes in clinical status can be difficult to define. Specific instances where a reassessment should be carried out to ensure patient and service user safety have been identified as after a surgical or interventional procedure in hospital, and after a person's care environment changes following a transfer in any setting.

Quality measures

Structure

a) Evidence of local arrangements to ensure that healthcare professionals know how to carry out a risk assessment to reassess the risk of developing pressure ulcers.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that people who have had a surgical or interventional procedure, or who have been transferred between care environments, have their pressure ulcer risk reassessed afterwards.

Data source: Local data collection.

Process

a) Proportion of inpatient hospital interventional or surgical procedures that have a pressure ulcer risk reassessment carried out while the person is in hospital.

Numerator – the number in the denominator that have a pressure ulcer risk reassessment carried out after the interventional or surgical procedure while the person is in hospital.

Denominator – the number of inpatient hospital interventional or surgical procedures.

Data source: Local data collection.

b) Proportion of changes in care environment following a transfer that have a pressure ulcer risk reassessment carried out afterwards.

Numerator – the number in the denominator that have a pressure ulcer risk reassessment carried out after the change in care environment.

Denominator – the number of changes in care environment following a transfer.

Data source: Local data collection.

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

Service providers (primary care, community care, hospitals and care homes with nursing) ensure that systems and protocols are in place for healthcare professionals to be trained in assessing pressure ulcer risk and that they carry out a pressure ulcer risk reassessment after an interventional or surgical procedure in hospital, or after a change in care environment following a transfer.

Healthcare professionals ensure that they know how to assess a person's pressure ulcer risk, and that they carry out a pressure ulcer risk reassessment after an interventional or surgical procedure in hospital, or after a person's care environment changes following a transfer.

Commissioners (NHS England area teams, clinical commissioning groups) ensure that a pressure ulcer risk reassessment is carried out for all people after a surgical or interventional procedure in hospital, or after a change in care environment following a transfer in all settings.

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

People who have had an operation or investigation in hospital have an assessment afterwards to see if they are at risk of developing a pressure ulcer.

People who are discharged from hospital, or who move wards while they are in hospital, have an assessment afterwards to see if they are at risk of developing a pressure ulcer.

Source guidance

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]

Change in care environment following a transfer

Examples of a change in a person's care environment following a transfer include:

  • when moving between wards in a hospital

  • on discharge from hospital to a care home, or their own home.

[Expert consensus]

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.