Rate of hospital-acquired pressure injuries (stages 3 and 4 and unstageable) (prepopulated)

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Patients within hospitals are at risk of developing pressure injuries. Cases of pressure injuries have risen steadily in Ontario, from about 1,245 per 100,000 hospitalizations in 2020/21 to about 1,920 per 100,000 hospitalizations in 2024/25. Advanced-stage (stages 3 and 4 and unstageable) and hospital-acquired pressure injuries are preventable and are identified as a hospital never event. Pressure injuries contribute to longer hospital stays and increased risks for significant patient harm (pain, infection, mortality) and to patient safety. Reducing hospital-acquired pressure injuries is a patient safety priority. Pressure injuries can be prevented through early detection and intervention to significantly reduce incidence and severity

Key resources

Ontario Health’s Quality Standard – Pressure Injuries: Care for Patients in All Settings
Ontario Health’s Pressure Injury Prevention Placemat
Ontario Health’s Pressure Injury Quality Standard Community of Practice
RNAO Best Practice Guideline, Pressure injury management: Risk assessment, prevention and treatment
National Pressure Injury Advisory Panel International Guideline, Prevention and Treatment of Pressure Ulcers/Injuries
HIROC Mitigation Strategies
Wounds Canada, Best Practice Recommendations For Skin Health and Wound Management 2025
Healthcare Excellence Canada, Hospital Harm: Pressure Ulcer

Change Ideas

Refine local data collection, and review data regularly

Review data sources related to pressure injuries to understand your organization’s current state and pressure injury data:
Ontario Health’s Pressure Injuries Quality Standard (HAPI) eReport; requires a ONEID account – please contact QualityandPatientSafety@ontariohealth.ca for assistance
Canadian Institute for Health Information (CIHI) Hospital Harm Project data; overview of “pressure ulcer” rates is available
Refine local processes related to how data is collected, reported, and actioned:
Monitor real-time rates and review your local organizational data, electronic medical records (EMRs), skin assessment reports, incident-reporting systems
Standardize definitions and documentation by implementing an organization-wide standard to identify, stage, and document pressure injuries. Adopt standard criteria for pressure injury stages, define “hospital-acquired,” and use standardized templates across units:
RNAO Best Practice Guideline, Pressure injury management: Risk assessment, prevention and treatment

Build capacity and establish wound care champions to strengthen prevention efforts

Identify clinical champions (interdisciplinary) to lead initiatives, education, and ongoing support for staff:
Nurses Specialized in Wound, Ostomy and Continence Canada
Wound, Ostomy and Continence Institute, Skin Wellness Associate Nurse (SWAN™) Program
Implement regular interdisciplinary huddles, rounds, and debriefs around skin and wound discussions
Support accountability and continue to incorporate pressure injury prevention into processes and structures

Standardize assessments and focus efforts on early-risk identification and escalation pathways

Embed risk assessments (e.g., Braden Scale) into admission process and daily workflows
Complete risk assessments within 24 hours of admission, with regular re-assessments or re-positioning schedules:
Wounds Canada, Best Practice Recommendations for Skin Health and Wound Management 2025 – provides discussion on assessing/re-assessing
RNAO Best Practice Guideline, Pressure injury management: Risk assessment, prevention and treatment) – provides assessment support, tools, and care bundle
Ensure there are timely dashboards or alert systems/processes for high-risk patients
Develop clinical pathways and workflows within EMRs for prompting and reminders:
Wounds Canada, Pathway for Preventing and Managing Pressure Injuries