Patient handout

Pressure injury (staging and management)

PRODUCTION

1. Your condition

This handout is for pressure injury (staging and management). Your care team identified this based on: skin breakdown / non-blanchable erythema / blister over sacrum, heel, ischium, trochanter, occiput (npiap/epuap 2019).

Other reasons your team may use this plan: immobility / bedbound / icu / spinal cord injury / advanced frailty — at-risk skin (npiap/epuap 2019); braden scale <=18 (mild) / <=12 (high) on admission or routine reassessment (braden & bergstrom 1987); skin injury under medical device (mask, tube, collar, splint, oximetry probe) — device-related pressure injury (npiap/epuap 2019).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
braden_risk_assessment_and_full_skin_inspection	—	—	—	NPIAP/EPUAP 2019 — structured risk tool (Braden: sensory perception, moisture, activity, mobility, nutrition, friction/shear) combined with clinical judgement plus head-to-toe skin inspection; reassess on condition change

Plan: Pressure injury — risk assessment → prevention bundle → stage-based wound care → infection mgmt → NPWT/flap → goals-of-care

3. When to call your provider

Contact your care team if any of the following happen:

Spreading erythema, fever, or systemic signs → urgent in-person evaluation / ED for possible sepsis (Sepsis-3 2016)
Non-healing Stage 3/4 after optimised care → wound clinic + plastic surgery referral (NPIAP/EPUAP 2019)
New Unstageable lesion or rapidly evolving DTPI → expedited specialist review (NPIAP/EPUAP 2019)
Caregiver unable to deliver prevention bundle → escalate support / consider higher level of care (NPIAP/EPUAP 2019)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Sepsis arising from an infected pressure injury — qSOFA >=2 or NEWS2 high-risk with an infected Stage 3/4 wound (Sepsis-3 2016; NPIAP/EPUAP 2019)(life-threatening)
Necrotizing soft-tissue infection complicating a pressure injury — crepitus, rapidly spreading erythema, pain out of proportion, hemorrhagic bullae, systemic toxicity (NPIAP/EPUAP 2019)(life-threatening)
Stage 4 pressure injury with exposed bone / positive probe-to-bone and biopsy-confirmed osteomyelitis (NPIAP/EPUAP 2019)
Deep tissue pressure injury evolving rapidly to full-thickness loss within hours-to-days despite offloading (NPIAP/EPUAP 2019)

5. Follow-up

Care-transition skin handoff (POA documentation, stage, support surface continuity), caregiver/patient education on repositioning and skin checks, recurrence-prevention plan, dietitian follow-up, wound clinic / WOCN review, advance care planning and goals-of-care revisited at each transition; quality/never-event reconciliation for hospital-acquired Stage 3/4/Unstageable/DTPI (NPIAP/EPUAP 2019)

6. Sources

Guideline: 2019 NPIAP/EPUAP/PPPIA International Pressure Ulcer/Injury Clinical Practice Guideline; 2024 updates; NPIAP 2016 staging revision