pressure ulcer? What was the Pressure Ulcer risk assessment score on the date the pressure ulcer was noticed? Enter Score Other information relevant to this section: Prior to the initial observation of the pressure ulcer, did the service user have any of the following additional risk factors for pressure ulcer development Sensory impairment (neurological disease resulting in reduced sensation and insensitivity to pain Yes No Reduced level of consciousness Yes No Deterioration in service users condition whereby the service user may have been hypotensive, Yes No hypothermic, hypoxic, pyrexia, septic etc. Has the service user had a period of prolonged collapse / injury / immobilisation which may Yes No correlate with presentation of tissue damage? Severe chronic or terminal illness (multi-organ failure, poor perfusion and immobility) Yes No Previous history of a pressure ulcer at site of current pressure ulcer ulceration Yes No Diagnosed or suspected Peripheral Vascular Disease Yes No Sustained pressure from medical related device e.g. from orthopaedic casting, tubing etc. Yes No Is there evidence that the medical team / GP were aware of the service risk status No user’s elevated Yes N/A for pressure damage/developing skin damage? Other information relevant to this section: Key Points of Pressure Ulcer Prevention Plan Is there evidence that a pressure ulcer prevention plan is in place (e.g. SSKIN bundle or specific Yes No pressure ulcer care plan) If Yes, Date commenced: Time commenced: Is there evidence that the pressure ulcer prevention plan in place (e.g. SSKIN bundle or specific pressure ulcer care plan) was completed in full as appropriate to the date the service user was Yes No assessed as ‘at risk’. Other information relevant to this section: SURFACES Date In use at time PU Equipment Indicated Type Date Ordered Available identified? Mattress Yes No Yes No Cushion Yes No Yes No Heel Protectors Yes No Yes No No Has the service user been referred to the Occupational Therapist for additional advice of Yes N/A specialised seating / equipment? Other information relevant to this section: SKIN INSPECTION Is there documented evidence that skin was inspected within 6 hours of presentation to Yes No Emergency Department, admission to the ward or on first community visit?
pressure ulcer? What was the Pressure Ulcer risk assessment score on the date the pressure ulcer was noticed? Enter Score Other information relevant to this section: Prior to the initial observation of the pressure ulcer, did the service user have any of the following additional risk factors for pressure ulcer development Sensory impairment (neurological disease resulting in reduced sensation and insensitivity to pain Yes No Reduced level of consciousness Yes No Deterioration in service users condition whereby the service user may have been hypotensive, hypothermic, hypoxic, pyrexia, septic etc. Yes No Has the service user had a period of prolonged collapse / injury / immobilisation which may correlate with presentation of tissue damage? Yes No Severe chronic or terminal illness (multi-organ failure, poor perfusion and immobility) Yes No Previous history of a pressure ulcer at site of current pressure ulcer ulceration Yes No Diagnosed or suspected Peripheral Vascular Disease Yes No Sustained pressure from medical related device e.g. from orthopaedic casting, tubing etc. Yes No Is there evidence that the medical team / GP were aware of the service user’s elevated risk status for pressure damage/developing skin damage? Yes No N/A Other information relevant to this section: Key Points of Pressure Ulcer Prevention Plan Is there evidence that a pressure ulcer prevention plan is in place (e.g. SSKIN bundle or specific pressure ulcer care plan) Yes No If Yes, Date commenced: Time commenced: Is there evidence that the pressure ulcer prevention plan in place (e.g. SSKIN bundle or specific pressure ulcer care plan) was completed in full as appropriate to the date the service user was assessed as ‘at risk’. Yes No Other information relevant to this section: SURFACES Equipment Indicated Type Date Ordered Date Available In use at time PU identified? Mattress Yes No Yes No Cushion Yes No Yes No Heel Protectors Yes No Yes No Has the service user been referred to the Occupational Therapist for additional advice of specialised seating / equipment? Yes No N/A Other information relevant to this section: SKIN INSPECTION Is there documented evidence that skin was inspected within 6 hours of presentation to Emergency Department, admission to the ward or on first community visit? Yes No