Skin Safety Protocol: Risk Assessment and Prevention of Pressure Ulcers

Clinical Highlights and Recommendations

  • Risk assessment should be performed in both the outpatient and inpatient settings. For outpatient, a set of questions answering yes or no should be used. For inpatient, use of a standardized risk assessment tool is recommended. The work group recommends the Braden Scale. (Footnote #1)
  • A head-to-toe skin inspection should be done on every patient within six hours of admission, and re- inspection should occur every 8-24 hours, depending on the status of the patient. (Footnote #2)
  • The skin safety plan should include interventions that minimize or eliminate friction and shear, mini- mize pressure, manage moisture, and maintain adequate nutrition/hydration. (Footnote #3)
  • Document all risk assessments, skin inspection findings and skin safety plans. Utilize a consistent documentation format. (Footnote #4)
  • Communication of pressure ulcer development, risk assessment and skin inspection results should be done consistently. Any change in skin condition should be communicated as soon as observed. (Foot- note #5)

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2010 © Foro Latinoamericano Colaborativo en Calidad y Seguridad en Salud

Desarrollado por IECS (Instituto de Efectividad Clínica y Sanitaria)

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