Self-Assessment Worksheet for Pressure Ulcer Healing

This self-assessment tool is an important first step in implementing the On-Time electronic reports into current workflow to help inform pressure ulcer wound interventions and improve healing rates. The worksheet will help you understand current practices and identify gaps in identifying risk, communicating risk, and receiving input from a multidisciplinary team. This assessment should show how well the nursing home:

• Identifies pressure ulcer nonhealing risk factors using information from multiple sources.
• Develops interventions specific to the risk factors to mitigate risk.
• Communicates the intervention to all staff using multiple processes.

This assessment will cover the following:

• Section 1. Pressure Ulcer Tracking and Assessment
• Section 2. Pressure Ulcer Healing Practices
• Section 3. Investigations/Root Cause Analysis of Pressure Ulcer Healing
• Section 4. Communication Practices

Section 1: Pressure Ulcer Tracking and Assessment     

1. What tools, if any, do you use to monitor pressure ulcer healing? Check all that apply.

2. How often do you reassess pressure ulcers?
   1. ___ Daily
   2. ___ Weekly
   3. ___ Monthly
   4. ___ Other (specify): _____________________________________________________
3. Do you collect the following information?

4. How often is the information updated?
   1. Total count of pressure ulcers is updated:
      ___ Daily
      ___ Weekly
      ___ Every 2 weeks
      ___ Monthly
      ___ Quarterly
   2. Total count of pressure ulcers by stage is updated:
      ___ Daily
      ___ Weekly
      ___ Every 2 weeks
      ___ Monthly
      ___ Quarterly
5. Does your assessment of pressure ulcers include the following items:

Section 2: Pressure Ulcer Healing Practices

1. Do you have a protocol for monitoring the progress of pressure ulcer healing?
    Yes ___ No ___ If no, explain: ________________________________________________________________
2. What guidelines are used in your facility protocol regarding evaluating pressure ulcer healing? Check all that apply. If none, skip to Section 3.
   ___ AMDA – The Society for Post-Acute and Long-Term Care Medicine’s Pressure Ulcer Guidelines
   ___ National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance’s Prevention and Treatment of Pressure Ulcers Guidelines
   ___ Wound, Ostomy, and Continence Nurses Society (WOCN) Pressure Ulcer Guidelines
   ___ Other (specify): __________________________
   ___ None of the above
3. Does your facility’s protocol include criteria for identifying residents whose pressure ulcers may not heal in a reasonable timeframe due to resident comorbidities and/or wound characteristics (i.e., identification of residents who are at risk for delayed healing before delayed healing is evident)?
   Yes ___ No ___
4. Does your facility’s protocol include criteria for identifying ulcers that are not healing in an expected timeframe? Yes ___ No ___
   If yes, what are the criteria?
   ____________________________________________________________________________________________

   ____________________________________________________________________________________________

5. Does your facility protocol provide guidance on:

Section 3: Investigations/Root Cause Analysis of Delayed Pressure Ulcer Healing

1. Do you investigate delayed healing pressure ulcers according to your facility’s policies and guidelines?
   Yes ___ No ___ Not Sure ___
2. Do you investigate delayed pressure ulcer healing via a root cause analysis framework?
   Yes ___ No ___ Not Sure ___ If no, skip to Section 4.
3. Does your investigation include a review of changes to the resident’s clinical status that may have warranted a change in pressure ulcer care approaches?
   Yes ___ No ___ If no, skip to Question 5.
4. Which of the following changes to the resident’s clinical status would be considered when determining if a change in pressure ulcer care approaches is needed?  Check all that apply.
   ___ Change in condition
   ___ Weight loss
   ___ Change in meal intake
   ___ Change in fluid intake
   ___ Change in mobility
   ___ Change in continence
   ___ Change in ability to communicate pain
5. Which of the following changes to the resident’s clinical status would be considered when determining if a change in pressure ulcer care approaches is needed?  Check all that apply.
   ___ Nutritional interventions to meet the resident’s hydration, protein, calorie, vitamin, and mineral needs
   ___ Incontinence prevention and/or management
   ___ Management of medical device-related pressure
   ___ Pressure redistribution (e.g., support surfaces) and offloading (e.g., specialized footware)
   ___ Friction and sheer reduction
   ___ Turning and repositioning procedures
   ___ Treatment changes per frequency designated by protocol or provider
   ___ Indicators for debridement
   ___ Assessment for appropriate bed and chair support surfaces
   ___ Skin assessments per frequency designated by protocol or provider
   ___ Dressing protocols
   ___ Infection prevention and assessment
   ___ Other (specify):

Section 4: Communication Practices

1. Review the following list of meetings. For every meeting that occurs at your facility, indicate how often it occurs, who leads the meeting, and who attends. Also indicate if the meeting includes any discussion of pressure ulcer healing

Key: CNA = certified nursing assistant; QAPI = Quality Assessment and Performance Improvement; APRN = advanced practice registered nurse.

2. Training.

Indicate the date of the most recent training provided for the following:

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