Pressure Ulcer Passport

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This is a record of the treatment you are receiving for your pressure ulcer injury. Please bring it with you to all your healthcare appointments. This will help the staff caring for you give you the most appropriate treatment.

Patient:

Information for patients

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What is a pressure ulcer (PU)

Pressure ulcers (bedsores or pressure sores) are injuries to your skin and/or the underlying tissue. You usually get them over a bony area. They are usually caused by pressure on your skin.

They can range from patches of discoloured skin (stage 1 pressure ulcer/PU) to open wounds where the underlying bone or muscle show through (deep tissue injury). Below are some examples.

How are pressure ulcers treated?

Treatment depends on the ‘stage’ of your ulcer. It can include regularly changing your position or using a special mattress or heel protector to relieve pressure. In some cases, you may need surgery.

Dressing your pressure ulcer

A nurse will assess your ulcer and recommend a care plan to treat it. Many types of dressing are used to treat pressure ulcers. Your district nurse, tissue viability nurse or GP (home doctor) will choose the right dressing for your pressure ulcer. Most dressings are left on for several days, while others may need changing more often.

Stage 1 PU Stage 2 PU Stage 3 PU Stage 4 PU

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The following pages give details of your pressure ulcer, your needs and the treatment you are receiving. It helps ensure you get the correct treatment. The nurses caring for you will ask you some questions about your needs to help them fill it in.

Patient and GP details

Name: DOB: NHS number: Tel no: GP: Patient address: Tel no:

Key contacts: District Nurse � Residential Home � Trust TVN � Nursing Home � Community TVN � Address: Tel no: � Other:

� Allocated case manager:

Medical conditions that may affect my wound:

Sensation:

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Pressure ulcer history

Date pressure ulcer first identified Date: Where did ulcer originate?

(Please indicate)

Own home � Hospital � Nursing Home � Residential Home � Other (Please state)

Previous pressure ulcer history: Yes � No � Has pressure ulcer healed: Yes � No � Site of pressure ulcer/s:

Date pressure ulcer reported on DATIX (for hospitals or own home):

Date pressure ulcer reported to CQC for Nursing/Residential homes:

Initial stage of pressure ulcer: If stage 3 or 4 pressure ulcer, please provide

STEIS No:

Date reported on STEIS:

Hospital re-admission

Any deterioration: Yes � No � Current stage:

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What is relevant for my skin health? My mobility:

� I spend most of the day in bed or on a chair � I need help getting in and out of bed or my chair � I need reminding to turn

� I need to be turned every ………hours � I need to be turned each visit

Heel ulcer?

Any known vascular disease/ diabetes of the lower limb? Yes � No � ABPI �

Date of results:

Is the patient known to the podiatrist/diabetic foot practitioner? Yes � No � Date: Comments: MDT review: Yes � No � Date: ……… Dietician referral: Yes � No � Date: ……… Physiotherapy referral: Yes � No � Date: ………

Tissue Viability Nurse referral::

Yes � No � Date: ………

Food and drink:

I eat a full meal……times a day I take food supplements (dietician) Yes � No �

I need help with my meals Yes � No �

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Continence management:

� I need assistance with toileting � I use continence products � I have a catheter Incontinent Associated Dermatitis: Yes � No � Products used: Weight: I weigh………stones/kg

Pressure Ulcer Staging

Stage 1- Intact skin with

non-blanching redness of a localised area usually over a bony prominence.

Stage 2 - Partial thickness loss of the

dermis presenting as a shallow open ulcer.

Stage 3 - Full thickness tissue loss.

Subcutaneous fat may be visible but bone, tendon or muscle are not exposed.

Stage 4 - Full thickness tissue loss

with exposed bone, tendon or muscle.

Unstageable - Full thickness tissue

loss in which the base of the ulcers is covered by slough or eschar.

Suspected deep tissue injury -

depth unknown, presenting as a purple or maroon localized area of discoloured intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and or shear.

R L L R

Please indicate location and approximation of size of wound on theses drawings.

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Pressure ulcer record

Date: Date: Date: Date:

Location: Location: Location: Location:

Stage: Stage: Stage: Stage:

L W D L W D L W D L W D

Exudate Amount and Type:

Tissue Type (Necrotic, Slough Granular)

Pressure ulcer record

Date: Date: Date: Date:

Location: Location: Location: Location:

Stage: Stage: Stage: Stage:

L W D L W D L W D L W D

Exudate Amount and Type:

Tissue Type (Necrotic, Slough Granular)

Pressure ulcer record

Date: Date: Date: Date:

Location: Location: Location: Location:

Stage: Stage: Stage: Stage:

L W D L W D L W D L W D

Exudate Amount and Type:

Tissue Type (Necrotic, Slough Granular)

L = Length (cm) W = Width (cm) D = Depth (cm)

TVN = Tissue Viability Nurse

GP = General Practitioner DN = District Nurse NH = Nursing Home RH = Residential Home

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Equipment at home

Hospital bed: Yes � No �

Air mattress: Yes � No �

State type: Seating cushion (state type):

Heel protector: Yes � No �

Other:

Additional comments:

www.kch.nhs.uk Corporate Comms: 0531

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References

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