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Care Pathwa ys or Local Protocols Most sites (92%) report having a treatment protocol or a pressure ulcer standard of care (33%), but only 50% report using one of the published CPGs (e.g., RNAO or PVA), emphasizing the disconnection between previously published CPGs and current practice implementation. Practice References 1. Regan M, Teasell RW, Keast D, Aubut JL, Foulon BL, Mehta S. Pressure ulcers following spinal cord injury. In: Eng JJ, Teasell RW, Miller WC, et al., eds. Spinal Cord Injury Rehabilitation Evidence. Version 3.0. Vancouver, BC; 2010. http://www.scireproject.com/ rehabilitation-evidence/pressure-ulcers. Accessed May 29, 2012. 2. Black J, Baharestani M, Cuddigan J, et al. National pressure ulcer advisory panel’s updated pressure ulcer staging system. Urol Nurs. 2007;27:144-150. 3. Keast DH, Parslow N, Houghton PE, Norton L, Fraser C. (2006). Best practice recommendations for the prevention and treatment of pressure ulcers: Update. Wound Care Canada. 2006;22-32. 4. Mortenson WB, Miller WC. Scales for assessing the risk of developing a pressure ulcer in individuals with SCI. Spinal Cord. 2008;46:168-75. Wound Assessments 1. A variety of wound assessment tools are in use any use%; routine use% by sites for: a. Characterization and/evaluation of pressure ulcers: • Bates Jenson Wound Assessment Tool (BWAT) 0%;0% • Pressure Ulcer Stages (1989). National Pressure Ulcer Advisory Panel (NPUAP) (http://npuap.org/positn6.htm) 50%; 25% • High definition diagnostic ultrasound assessment (see below) of deep tissue integrity (further validation of tool is required) 8%; 8% • Cardiff Wound Impact Scale (CWIS) 8%; 0% • Wound tracer 42%; 0% • Measure 42%; 17% • Photograph 8%; 0% b. Prediction of who will develop a pressure sore: • Braden Scale 92%;50% • Spinal Cord Injury Pressure Ulcer Scale Measure 0;0% • Pressure maps 8%;0% • Site-specific assessment tool 1%;8% Interestingly, no sites report routine use of pressure maps for SCI inpatients. All sites, however, either own or have access to – with 67% reporting adequate access to – pressure-mapping equipment, despite controversy over pressure map data interpretation.6 There is considerable controversy over the optimal process for, and role of, pressure mapping within wheelchair seating prescription. Many confounding factors related to the individual (intrinsic, extrinsic, and physiological characteristics), their assessment position, injury duration and the physical attributes of the equipment itself, contribute to the controversies related to routine clinical use and interpretation of pressure mapping data. Interrater reliability studies suggest that pressure mapping is only reliable for areas of maximum pressure and that, in the quest for adequate pressure distribution, sole reliance on visual interpretation of pressure maps may lead to inappropriate cushion provision. There is a ‘disconnect’ between access to pressure mapping devices, and their routine use in prevention and management of pressure sores in Canada, that merits further enquiry (see photo of pressure mapping process above). SKIN INTEGRITY | BODY STRUCTURE AND FNUCTION 87


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