User Interface Name

Field Identifier

Definition

Data Value Format (code or other value)

Value Sets

Date of Assessment

Assessment_Date

This is the date the actual assessment was carried out with the patient

8 digit numeric, CCYYMMDD
6 digit numeric: hh:mm:ss

Mobility status - tick all applicable

Mobility_status

This is to indicate the patients current mobility status

n1

1 - Needs the help of another person to walk
2 - Spends all or the majority of time in bed or chair
3 - Remains in the same position for long periods
4 - Walks independently with or without walking aids

Skin Status - tick all applicable

Skin_status

This is to indicate the patients current skin status

n1

1 - Current PU category 1 or above?
2 - Reported history or previous PU?
3 - Vulnerable skin
4 - Medical device causing pressure/shear at skin site e.g. O, mask, NG tube
5 - Normal skin

Clinical Judgement - tick as applicable

Clinical_judgement

This is the clinical judgement of the patients condition

n1

1 - Conditions/treatments which significantly impact the patients PU risk e.g. poor perfusion, epidurals, oedema, steroids
2 - No problem

Frequency of position changes

Position_changes_frequency

This is to indicate the frequency of the patients position changes

n1

1 - Doesn't move
2 - Moves occasionally
3 - Moves frequently

Extent of all independent movement
(Relief of all pressure areas)

Independent_movement_extent

This is to indicate the extent of the patient independent movement

n1

1 - Doesn't move
2 - Slight position changes
3 - Major position changes

Sensory perception and response - tick as applicable

Sensory_perception_response

This is to indicate the patients sensory perception and response

n1

1 - No problem
2 - Patient is unable to feel and/or respond appropriately to discomfort from pressure e.g. CVA, neuropathy, epidural

Moisture due to perspiration, urine, faeces or exudate - tick as applicable

Moisture

This is to indicate if any moisture in said form on the skin

n1

1 - No problem / occasional
2 - Frequent (2-4 times a day)
3 – Constant

Perfusion - tick all applicable

Perfusion

Defined as the passage of a fluid through the circulatory system. The question indicates if there are any identified issues related to perfusion

n1

1 - No problem
2 - Conditions affecting central circulation e.g. shock, heart failure, hypotension
3 - Conditions affecting peripheral circulation e.g. peripheral vascular / arterial disease

Nutrition - tick all applicable

Nutrition

This is to indicate the patients current nutrition status

n1

1 - No problem
2 - Unplanned weight loss
3 - Poor nutritional intake
4 - Low BMI (less than 18.5)
5 - High BMI (30 or more)

Medical device - tick as applicable

Medical_device

This is to indicate if a medical device affects the skin in relation to shearing and pressure damage

n1

1 - No problem
2 - Medical device causing pressure/shear at skin site e.g. O2, mask, NG tube

Diabetes - tick as applicable

Diabetes

This is to indicate whether or not the patient is diabetic

n1

1 - Not diabetic
2 – Diabetic

Previous PU history - tick as applicable

PU_history

This is to indicate the patients pressure ulcer history

n1

1 - No known PU history
2 - PU - History (complete below)

Scar

PU_scar

This is to indicate whether the pressure ulcer scarred the patient

No scar

PU_no_scar

This is to confirm that there was no scar from the pressure ulcer

Skin site

Skin_site

This is to indicate which skin site the patient has pain

n1

1 - Sacrum
2 - L Buttock
3 - R Buttock
4 - L Ischial
5 - R Ischial
6 - L Hip
7 - R Hip
8 - L Heel
9 - R Heel
10 - L Ankle
11 - R Ankle
12 - L Elbow
13 - R Elbow

Pain

Pain_present

This is to indicate whether there is pain is present in any skin site

Vulnerable skin

Vulnerable_skin

This is to indicate if the patient has vulnerable skin

PU Category

PU_category

This is to indicate which category the patients pressure ulcer is

Normal Skin

Normal_skin

This is to indicate that the patient has normal skin