[CG] Pressure Ulcer Daily Risk Assessment (PUDRA) Guidance


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This daily risk assessment helps you to identify a person at risk of developing a pressure ulcer. It focuses on a collection of factors which we know lead to pressure ulcers developing.

PUDRA records a pressure ulcer daily risk assessment on the front page and there is an interventional plan of care on the back page for people who are identified at risk; have redness; or existing pressure damage.

Q. Do I still need to do a Waterlow risk assessment?
A. No. The pressure ulcer daily risk assessment (PUDRA) replaces the Waterlow as the pressure ulcer risk assessment tool.

Q. How often should PUDRA be done?
A. On admission to hospital and your clinical area, and then must be reassessed daily, or more frequently if a person’s condition changes.

Q. What is the Interventional Plan on the back page?
A. The interventional plan is the plan of care to be used to reduce the risk of pressure damage, or existing pressure damage deteriorating.

Q. When do you complete the Interventional Plan?
A. After assessment using PUDRA (front page) and identifying a person at risk or who has existing pressure damage.

Q. Who should complete the Interventional Plan?
A. The registered nurse completing the risk assessment, in partnership with patient and / or carer.

Q. When should the Interventional Plan be updated?
A. If the person’s condition or circumstances change.

Q. Do I also need to document interventions in the nursing care plan?
A. No, as the interventional plan is the SSKINS care bundle plan of care.

Q. Do I still need to do Active Care?
A. Yes. Active Care is the record of care delivered within a prescribed timescale. PUDRA will guide you to what that timescale should be.

Q. How does this fit in with the pressure ulcer safety bundle?
A. PUDRA is the risk assessment tool and SSKINS interventional plan. They address a number of elements of the pressure ulcer safety bundle with the aim of reducing harm.

Q. How does this fit with CAAS?
A. The PUDRA and interventional plan, when used in conjunction with the pressure ulcer safety bundle, provides the evidence of care which meets 7 elements of Standard 1, Pressure Area Care.

If a patient develops grade 2, 3 or 4 pressure damage in your clinical area you must refer to tissue viability on Trakcare, carry out a red day review in conjunction with the tissue viability nurse, and then record in Datix. The pressure ulcer grading tool and moisture damage tool (2015) must be used to ensure accurate diagnosis of pressure damage.

Further information can be obtained by contacting Tissue Viability Service 0141 300 6317 and from the tissue viability website on Staffnet.

Last reviewed: 01 October 2015

Next review: 31 August 2021

Author(s): Claire Rowan

Co-Author(s): Diana Clark, Lead Midwife, QEUH