Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Management of causative/contributing factors
Recommendation Level of Evidence
2.1  Choose the support surface which best fits with the overall care plan for the client considering the goals of treatment, client bed mobility, transfers, caregiver impacts, ease of use, cost/benefit, etc. Ensure ongoing monitoring and evaluation to ensure that the support surface continues to meet the client’s needs and that the surface is used appropriately and is properly maintained. If the wound is not healing, consider the total care plan for the client before replacing the surface. IV
2.2  Pressure management of the heels while in bed should be considered independently of the support surface. III
2.3  Use pressure management for clients in the Operating Room to reduce the incidence of pressure ulcers post operatively. Ia
2.4  Obtain a seating assessment if a client has a pressure ulcer on a sitting surface. IV
2.5  Refer patients at RISK to appropriate interdisciplinary team members (Occupational Therapist, Physiotherapist, Enterostomal Therapist, etc.). Utilize those with expertise in seating, postural alignment, distribution of weight, balance, stability and pressure management when determining positioning for sitting individuals. Ensure support surfaces are used appropriately and are properly maintained. IV
2.6  A client with a pressure ulcer on the buttocks and/or trochanter should optimize mobilization. If pressure on the ulcer can be managed, encourage sitting as tolerated. IV

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