1. AAWC Pressure Ulcer Guideline
Content Validated, Evidence Based “Guideline of Pressure Ulcer Guidelines”

2. Using the AAWC Pressure Ulcer (PU) Guidelines to Manage Pressure Ulcers
3 Steps to manage a PU patient:
Assess and document patient, skin & PU
Prevent PU with care plan focused on reducing risk
Treat patient and PU to heal and prevent recurrence
For guideline details, references, implementation tools, patient brochure and evidence please see:

3. Fonts Used in This PPT and in the AAWC PU Guideline Checklist
Recommendations in bold font are
Ready to Implement :
A-level evidence support
+ Content validity index (CVI)>0.75
Recommendations in bold italics
Need more Education
Content validity index (CVI) <0.75 (Raters say not relevant to PU)
Recommendations in normal font
Need more research to be considered evidence-based , but have a CVI of at least 0.75,
i.e. 75% of independent raters or more believed this recommendation was clinically relevant for PU practice.

4. Using the AAWC Pressure Ulcer Guidelines to Prevent/Manage Pressure Ulcers
Assess and document patient’s skin
Prevent pressure ulcers (PU) as feasible.
Focusing on those at risk of developing a PU
Treat patient and PU to heal as feasible

5. Pressure Ulcer Management
If feasible manage with a interdisciplinary wound care team or appropriate consults as needed by the individual receiving care.

6. Assess the Patient’s Skin
Trained staff regularly assess skin sites at risk
By 72 hours after admission or per setting protocol
Usually weekly and on change in patient status
Pay special attention to more darkly pigmented skin.
Document and plan care to address skin changes.
Assess skin areas where devices may cause pressure, e.g. splints, casts, tubes as feasible.

7. Evaluate and document patient medical/surgical history
Physical Exam
Include whole-body visual and tactile skin inspection within 72 h or protocol-specified time and regularly after admission identifying PU present on admission
Psychosocial condition
Environment
Goals, including quality of life
PU risk using clinical judgment + reliable, valid scale:
Braden, Norton, Waterlow +
Assess other validated risk factors:
Body mass index (BMI) extremes
Diabetes
Extremes of age

8. Document Progress Document pressure ulcer progress weekly
using reliable, valid measures, e.g.
length x width to estimate area.
Partial- or full-thickness depth assessment
Ensure formal assessments are accessible to those providing or consulting on PU care

9. Pressure Ulcer Prevention Address all patient PU risk factors identified 1. Limited mobility, activity, cognition, sensation
Redistribute pressure every 4 hr or as indicated or feasible
Properly trained staff select and use indicated pressure redistribution devices for beds, chairs and wheelchairs that meet psychological, social, anatomic and physiologic needs for those at PU risk, if appropriate for patient.
Use patient-appropriate positioning standards of care per institution protocol.
Implement appropriate exercise program as needed/feasible
Consistently train patient and care providers on PU prevention and treatment as appropriate and feasible

10. Pressure Ulcer Prevention Address all patient PU risk factors identified
Manage skin moisture:
Protect skin from excess moisture with barrier
Wick excess fluid away from skin
Patient-appropriate incontinence plan and skin-fold management if needed and feasible
Clean and gently dry skin after incontinence episodes

11. Pressure Ulcer Prevention Address all patient PU risk factors identified
Nutrition, circulation, infection:
Consult(s) as needed to identify/reduce PU risk
Consistent with patient and family goals and consult advice, restore, maintain good:
Hydration
Nutrition
Circulation
Infection control

12. Pressure Ulcer Prevention
Protect skin
from chemical or physical pressure or trauma
Avoid friction, shear, pressure on transfers
Special attention to splints, casts, tubes
Avoid vigorous massage
Moisturize dry skin to prevent cracking
Protect skin from excess moisture and heat
Attend to areas affected by incontinence or perspiration, and skin folds in bariatric patients

13. Treat Patient and Pressure Ulcer (PU) To Optimize Healing as Feasible
Continue or implement appropriate measures to prevent PU
Select and use appropriate effective pressure redistribution product(s) as feasible
For use on pressure sites for individuals with a PU
To avoid positioning directly on PU when on bed , chair or wheel chair surface, e.g. use cushions

14. Treat Patient and Pressure Ulcer (PU) To Optimize Healing
Manage local and systemic factors per institutional protocols and to meet patient and family needs and goals as feasible
Nutrition
Circulation
Infection
Other, such as neuromuscular spasticity, contractures
Cleanse PU with water or saline or non-toxic cleanser at 4-15 psi
Debride nonviable tissue
 autolytically surgically enzyme
Evaluate PU at each dressing change for signs and symptoms of clinical infection

15. Treat Patient and Pressure Ulcer (PU) To Optimize Healing
Dress/treat PU to maintain a moist environment, protect PU and local skin from friction, shear, pressure, trauma, irritation and excess exudate (e.g. fiber, foam or hydrocolloid dressings)
Manage PU-related pain to meet patient needs.
Identify and address all nutrient deficiencies.
4 weeks if there is no PU area ,
Re-evaluate and improve care plan
Consider adjunct therapy such as electrical stimulation