Reposition Seated Patients - ️️Patients should be seated in a way that minimizes
pressure and prevents sliding and shear
Limit the time the patient spends seated in a chair
Patients who can reposition themselves should be taught to weight shift every 15
minutes for approximately 2 minutes
...
Module 3 & 4 NDNQI Pressure Injury
Reposition Seated Patients - ✔️✔️Patients should be seated in a way that minimizes
pressure and prevents sliding and shear
Limit the time the patient spends seated in a chair
Patients who can reposition themselves should be taught to weight shift every 15
minutes for approximately 2 minutes
Push-up weight shifts, forward-lean weight shifts, and side-lean weight shifts can be
used
Patients who cannot reposition themselves should be repositioned at least every hour
by a caregiver
Use a pressure redistributing chair cushion that is appropriate to the patient's needs.
Ensure that feet are properly supported on the floor, foot stool or foot rest.
Neonate Protection - ✔️✔️For neonates, soft bedding, high specification foam, or gel
mattress have been recommended for pressure redistribution
Children should be placed on a support surface that fits their body proportion and size.
Support surfaces such as a low-air-loss bed or alternating overlay should be age
appropriate and safe.
Because the occiput is the largest bony prominence in younger children, use a high
specification foam overlay or gel pad/pillow under the head to reduce occipital pressure.
Be sure to reposition the head periodically like any other high risk bony prominence.
Place a high specification foam cushion or gel under the head of children undergoing
surgery
Head Team Leader - ✔️✔️Be the hospital expert in skin and pressure injury risk
assessment
Be able to accurately stage pressure injuries using the NPUAP pressure injury staging
system
Be able to differentiate pressure injuries from other wound types and skin injuries
For NDNQI, the Head Team Leader must be familiar with NDNQI® Guidelines for Data
Collection and Submission on Pressure Injuries located on the member website
Adult Patient Pressure Injury Risk Assessment tools - ✔️✔️The Braden Scale, and the
Norton Scale, have been validated for adult use in research studies. These are the two
scales most commonly used in the United States
Pediatric/Neonate Pressure Injury Risk Assessment tools - ✔️✔️The Braden Q was
tested in PICU patients age 21 days to 8 years
The Glamogram Scale was tested in pediatric patients age 1 day to 18 years
The Neonatal Skin Risk Assessment Scale (NSRAS) was tested in Neonatal Intensive
Care Unit patients age 26-40 weeks gestation
, Pressure Injury Risk Assessment Scores - ✔️✔️Braden Scale scores range from 6 to
23
Norton Scale scores range from 5 to 20
Braden Q scores range from 7 to 28
NSRAS scores range from 6 to 24
For the Braden Scale, a score of 18 or less indicates that the patient is at risk for
pressure injuries
For the Norton Scale, a score of 15-16 or less indicates the patient is at risk for pressure
injuries
For the Braden Q, a score of 16 or less indicates the patient is at risk for pressure
injuries
For the NSRAS, a score of 13 or higher indicates the neonate is at risk for skin injury
Risk for Pressure Injury - ✔️✔️Skin Status
Existing pressure injuries
History of pressure injuries
General skin status
Decreased perfusion and oxygenation
Peripheral vascular disease
Hypotension
Use of vasopressors
Nutrition Related Examples
Recent weight loss
Protein energy malnutrition
Age Related Examples
Older age
Gestational prematurity
Surgery Related Examples
Operation greater than 4 hours
The number of hypotensive episodes intra-operatively
Low body temperature intra-operatively
Additional Examples
Exposure to pressure from a medical device such as oxygen tubing, CPAP mask,
cervical collar, etc.
Spinal cord injury
Increased body temperature
Program of Pressure Injury Prevention - ✔️✔️Daily Skin Assessment
Pressure Redistribution Surface Use
Routine Repositioning
Nutritional Support
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