Pressure Ulcers

At inception of the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) Best Practice Implementation project, funders determined that pressure ulcers would be the focus of implementation activities. Sites felt the most confident in how they managed pressure ulcers at their facilities, and it would be easiest to balance learning the skills to perform effective implementation of best practices for pressure ulcers.

The SCI KMN was fortunate to have access to the draft 2011 Canadian Best Practice Guidelines for the Prevention, Assessment, and Treatment of Pressure Ulcers in Individuals with Spinal Cord Injury by Houghton et al. There are 48 best practice recommendations in this draft guideline. The stakeholders within the SCI KMN Community of Practice voted in 4 iterative rounds of a Delphi consensus activity to choose the top 5 ranking recommendations considering the following factors: evidence, need, feasibility, importance, scalability and sustainability. Of the top 5 recommendations two were voted as non-negotiable and were to be implemented across all 6 sites:

Best Practice 1: Prevention
Conduct comprehensive, systematic and consistent
assessment of risk factors in individuals with SCI


Assess and document risk on admission and reassess on a routine basis, as determined by the health-care setting, institutional guidelines, and changes in the individual's health status.


Use clinical judgment as well as a risk assessment tool to assess risk


Assess demographic, physical/medical, and psychosocial risk factors associated with pressure ulcer prevention.


Best Practice 2
Structured education and provision of specific information


Provide structured pressure ulcer prevention education to help individuals post SCI gain and retain knowledge of pressure ulcer prevention practices.


Provide individuals with SCI, their families / significant others, and health-care professionals with specific information on effective strategies for the prevention and treatment of pressure ulcers, to assist with gaining and retaining knowledge.


A 5th round of the consensus Delphi activity was performed to determine the performance measures for these best practices.

Following the final decisions, the Knowledge Mobilization Specialist Team (KMST) has worked diligently to operationalize the recommendations into actionable components for fidelity implementation.  The SCI KMN achieved full implementation of pressure ulcer practices in early 2013.