Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

  • Pressure ulcers, also known as pressure sores, bedsores and decubitus ulcers, are areas of localized damage to the skin and underlying tissue.
  • This damage is generally a result of external forces – pressure, shear and/or friction.
  • Pressure ulcer development occurs in institutional and community settings, and is most often seen in elderly, debilitated and immobile (e.g., orthopaedic) clients, those with severe acute illness (e.g., those in intensive care units) and in individuals with neurological deficits (e.g., spinal cord injuries)
  • Mortality is associated with pressure ulcers – several studies have reported mortality rates as high as 60% for elders with a pressure ulcer within one year of discharge from hospital.
    • The pressure ulcer is not generally the cause of death, but rather it develops after a decline in the health status of the older person
  • Early intervention is essential for those at risk of developing pressure ulcers.
  • The principle components of early intervention are (National Pressure Ulcer Advisory Panel, 1992):
    • Identification of at-risk individuals who need preventive interventions and of the specific factors that place them at risk;
    • Protection and promotion of skin integrity;
    • Protection against the forces of pressure, friction and shear; and
    • Reduction of the incidence of pressure ulcers through educational programs for health professionals and clients.