Risk Assessment

Risk assessment

It is important when a person enters a new care setting that an assessment of their pressure ulcer risk is carried out. This assessment should take place as soon as possible, as pressure ulcers can develop quickly. It is also important to remember that a person’s condition can change which may mean a change in their pressure ulcer risk. It is good practice to re-assess a person’s risk of developing a pressure ulcer when there is a change in their condition. In order to identify quickly a change in a person’s pressure ulcer risk, undertake an assessment of pressure ulcer risk on a daily basis.

When a person is identified to be at risk of developing a pressure ulcer, communicate this to staff through shift handovers, safety briefings and through the use of ‘at risk’ cards and visual cues. For more information on risk assessment see the pressure ulcer prevention change package

Key resources for Risk Assesment

Development of a simplified risk assessment tool

As part of the National Tissue Viability Programme’s focus on pressure ulcer prevention, a high level pressure ulcer risk assessment tool was developed to make assessment of risk easier (Preliminary Pressure Ulcer Risk Assessment). 

We first of all identified a collection of risk factors through a 2-round method of consensus with Scotland’s Tissue Viability Nurse Experts. We then mapped these factors to those identified by an extensive systematic literature search forming part of a research programme undertaken by Professor Jane Nixon and colleagues (from the Leeds Institute of Molecular Medicine, School of Healthcare, Leeds Institute of Health Sciences and Leeds Teaching Hospitals NHS Trust).

Professor Andrea Nelson (from the University of Leeds), contributed to our working group, providing advice and support as the tool was developed and tested. In addition, we drew on the expertise of Dr Michael Clark, (formerly Professional Advisor to the Tissue Viability Society). 

We have also drawn on work in Wales where Mr Hamish Laing (Director of Acute Care and Consultant Plastic and Reconstructive Surgeon) and the team at ABM University Health Board, South Wales, tested a care bundle approach to pressure ulcer prevention. The elements of the care bundle are evidenced based actions, which when carried out together, minimise the occurrence of a pressure ulcer. Elements of the care bundle have also been mapped across to the collection of identified risk factors. 

Assessment linked to prevention

Building on its extensive improvement work in the area of pressure ulcer prevention, the National Tissue Viability Programme tested a streamlined approach to pressure ulcer risk assessment and preventative care. The framework used to guide this innovation project was the Institute of Healthcare Improvement 90-Day Research and Development Process, and was carried out in partnership with Annette Bartley (who is an independent Consultant and Director of UK Safer Patient Network).

The results of our work illustrate that  using a simplified tool to assess pressure ulcer risk,  serves as a trigger for timely, effective, evidenced based care to be delivered using a care bundle approach.

Published resources

Browse healthcare improvement resources:

Point of care - pressure ulcers

Scottish Patient Safety Programme logo

Click to download the Scottish Patient Safety Programme Pressure ulcers driver diagram.