NHS Scotland Pressure Ulcer Safety Cross
What are the key points I need to
- One box should be coloured daily. Simplicity
is key to the effectiveness of the safety cross.
- Record all pressure ulcers, regardless of
- Ensure that all staff in your ward/care home
are aware of the cross and know how to complete it.
- The safety cross should ideally be placed in
a public area, so everyone will see it on a regular basis (i.e.
ward measures board). This will provide an ‘at a glance’ view
of, for example, the number of patients/clients who are developing
a pressure ulcer in your ward/care home. This will enable you to
think about what changes you need to make to result in an
- Remember, you want to care for
patients/clients in such a way that you reduce the number of
pressure ulcers occurring (i.e. red boxes).
- Please be honest with your data; this is
data for improvement not judgment.
- Link the data you collect to an
For further information contact your local
Tissue Viability facilitator or RTC / LBC facilitator.
Outlined below are some common questions and answers about the
Why should the safety cross be
The Pressure Ulcer Safety Cross has a
number of key aims. You can use the data collected to:
- Raise awareness within the team and others regarding, for
example, how many pressure ulcers are acquired in your care area
(i.e. hospital ward, care home).
- Improve patient safety.
- Promote good practice (i.e. look at how many days have gone by
without a new pressure ulcer occurring).
- Provide real time incidence data.
- Llink the data to an improvement aim (see section on ‘What
do I do with this data?’).
How and who fills in the safety
Each safety cross represents one calendar
month. Within each cross there are 31 boxes, as each box represents
a single day. To the left of the cross is a key which lets you know
that each colour represents an outcome of a single day in your ward
or care home (see cross for colour guide). Each box should be
coloured at the end of the day (i.e. midnight) using the
appropriate colour. Where possible, only one colour should be used
per day. However it may be necessary for you to record ‘multi
coloured’ days especially if you have a high turnover of
patients/clients over a short time (i.e. if more than one colour is
required for a given day, consider splitting the date box). The
golden rule is to keep the format simple in order to make the
occurrence of a pressure ulcer immediately obvious. You can use
either colour pen or colour stickers to shade the boxes.
For the days that are coloured in either orange or red, you are
encouraged to record the number of pressure ulcers found on that
day. You can record this figure within the small box given for the
The Senior Charge Nurse or Nurse in Charge has responsibility
for ensuring the safety cross is completed. However the task of
completing the safety cross can be delegated to any member of the
Do I record the same pressure ulcer for more than
You only count an ulcer once. In order
to minimise double counting of pressure ulcers, it is recommended
that you record this in the table provided when a pressure ulcer is
identified. You can do this by recording the date the ulcer was
discovered for a particular patient/client, and the location of
that pressure ulcer. Remember that patient/client data needs to
remain confidential at all times, so consider putting the table on
the back of the safety cross. A pressure ulcer should be recorded
regardless of whether the patient/client developed an ulcer in your
ward/care home or was transferred into your ward/care home with an
ulcer. Remember to record the information in the patient’s/client’s
What do I do with this data?
is important to stress that each care area (i.e. hospital, ward,
care home) should have a clear aim in what they are trying to
achieve, otherwise the safety cross is seen merely as a reporting
tool. There are three fundamental questions to think about, the
answers to which form the basis of improvement;
- What are we trying to accomplish? (e.g. reduce hospital
acquired pressure ulcers by 50% within the next 6 months)
- How will we know that a change is an improvement? (i.e. use the
safety cross to enable us to see our incidence locally and act on
- What changes can we make that will result in improvement?
(e.g. use the tools available on http://www.tissueviabilityonline.com/
It is recommended that you keep all completed safety crosses for
your own records. At local level you can decide who should
gather in the safety cross at the end of the month for tallying.
Perhaps a ‘link nurse/carer’ for you ward/care home could be
nominated to help with this. You can then display this data in the
form of run charts.
The safety cross is not intended to replace the reporting
systems that you may already have in place, rather the safety cross
should complement them by encouraging early detection.
It is a good idea to let staff and patients/clients know on a
daily basis how many days have gone by without a new pressure ulcer
developing on your ward/care home. You can do this by simply
stating in a public area ‘It has been ___ days since a pressure
ulcer developed on this ward/care home’. This information
would be updated on a daily basis.
It is recommended that both your current safety cross, run chart
and simple statement on number of days are displayed on your ward
measures boards or in a visible area for patients/clients, public
and staff to see. Staff take great pride in knowing they have
improved their care.
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Published Date: 28/06/2009