Physical or Psychological Health |
Current CAPrI | 1. Do you have a pressure injury or a potential pressure injury right now? 2.Where is the pressure injury? Mark all locations where you think you have a pressure injury. 3.Have you done anything to try to fix the pressure injury? | Risk assessment: Consider impact of current or potential pressure injury on worsening or developing additional PrIs (1.2–1.5) | Assessment and reassessment of pressure injury: Describe and document in detail an existing pressure ulcer and its treatment; Monitor, assess, document, and report any observable/visible change in wound status | Veterans need to contact providers when they have skin breakdown or an issue. Providers instruct Veterans in CAPrI prevention, but Veterans should contact providers if there is an issue. | Veterans know their own bodies and can tell when there is an issue. Veterans engage in preventive care based on provider education or their own experience. |
Recent change in health status | 4.Recent change in health • Currently sick (e.g., flu, bad cold, I feel unwell) • Recent injury that affects me now • Recent surgery • Diarrhea • Change in pain • Change in feeling/ sensation • Change in balance; fall concern • Change in strength and ability to move • Don’t sleep well; tired • Change in skin | Assess for risk factors (1) Pain Surgery Nutrition Current pressure injury | Nutrition Change in daily routine Deterioration of health status | Exacerbation of acute or chronic condition makes it difficult to engage in preventive activities. | Acute sickness Injury Surgery Diarrhea Pain Bowel/bladder function Weight change/ appetite/diet, Feeling/sensation Balance/fall Strength/mobility Poor sleep Skin change Emotional concerns |
Chronic Conditions | 5.Do you have one or more of the following conditions? • Chronic obstructive pulmonary disease • Heart disease • High blood pressure • Diabetes (type 1 or type 2) • Peripheral vascular disease • Edema • Kidney disease/ dialysis • Fall and/or broken bone(s) • Past pressure injury • Post-traumatic stress disorder • Depression • Anxiety • Emotional concerns/difficulties affecting ability for selfcare 6.Depression Screen 7.How do I feel about the management of my chronic conditions • Well managed • Somewhat managed • Not well managed | Assess for risk factors (1) Age marital status gender ethnicity education comorbidities, particularly related to oxygenation or circulation | Level of injury Severity Duration Prior PrI Comorbidities | Level of injury Functional ability Aging Comorbidities | Level of injury Severity of injury Mobility Balance Continence Skin strength Pain Chronic conditions |
Motivation to prevent CAPrIs | 8.What motivates you to prevent pressure injuries? • I don’t want to have a pressure injury • I don’t want to be in the hospital • I have goals to achieve • My spirituality, faith, or purpose in life • Hope • My family • My friends • Other Veterans • Pets • My Healthcare providers • Other • I am not concerned about getting a pressure injury | None | Conflicting motivations can increase risk | Lack of Veteran motivation to perform preventive activities | Veteran motivation is a resource, not a risk |
SCI-specific |
Equipment | 9a.Equipment (bed/ mattress) 9b.Equipment (wheelchair, cushion) 9c.Equipment (bathroom) 9d.Equipment (other) Description of current equipment (per question) Last seating evaluation Issues (per question): • doesn’t work correctly • I am having difficulty using • I need a new • I am waiting for a new. How long? • I am willing to get a new • I have no problems | Support surfaces for pressure redistribution (7.1–7.15). Medical devices that minimize tissue damage (8) | Provide and maintain support surfaces (bed, mobility equipment) and home equipment; Seating evaluation | Interprofessional providers provide and maintain support surfaces and home equipment; Veteran may not want new equipment | Grateful to receive equipment from the VA, but sometimes it doesn’t work, difficult to use it, or it takes a long time to receive equipment; Veterans may not ask for new equipment. |
Supplies | 9e.Supplies (skin) 9f.Supplies (device) 9g.Supplies (footcare) 9h.Supplies (bowel/bladder) Identification of current supplies (per question) Identification of needed supplies (per question) | Skin barrier, absorbent incontinence products, silicone foam dressings (3.3) | Supplies for skin care, foot care, incontinence care | Collaboration among interprofessional team to determine and provide needed supplies | Grateful that VA provides supplies |
Skin Care | 9i.Visual assessment 9j.Skin care cleansing 9k.Skin care lotion Frequency (within/not within clinical guidelines) Problem/Issue • Need help • Don’t have caregiver • Need supplies • Forget/busy • Don’t want to do it | Skin assessment, blanchable erythema, temperature, edema. Clean skin, particularly after incontinence, avoid rubbing, wear low friction textiles. (3.1–3.5) | Daily skin visual assessment; Daily or every other day skin cleansing; Daily lotion application | Same as PVA guidelines; Veterans must be diligent; Veteran motivation is a risk | Veterans are vigilant in following CAPrI prevention recommendations. |
Bowel/ Bladder issues | 9l.Bladder urine leaks 9m.Bowel program Indicate issue(s) • Problems with bowel/bladder program • Recent changes to program • Noticed increased moisture on my skin/stool leaking • Waiting for new equipment or supplies. How long? • Willing to get new equipment or supplies • Willing to make changes to program | Use absorbent incontinence products (3.3) | Education in incontinence management; Clean skin immediately after incontinence episode | Providers address incontinence issues through care coordination, provide resources and education | Veterans are vigilant in following CAPrI prevention recommendations May lack caregiving assistance |
Positioning/mobility | 9n.Positioning/pressure relief routine—wheelchair 9o.Positioning/pressure relief routine—bed 9p.Positioning/pressure relief routine—transfer Frequency (within/not within clinical guidelines) Indicate issue (per question) • Inability • Lack of caregiver • Equipment/ supplies • Forget/busy | Reposition schedule for optimal offloading bony prominences (5). Off-load heels, prophylactic dressings (6) | Education in position changes and pressure redistribution | Veterans at lower risk for CAPrIs are diligent in positioning; Lack compliance with recommended positioning | Veterans sometimes forget or are busy living life; May not have caregiving assistance. |
Physical Activity | 9q.Positioning/pressure relief routine—activity exercise (frequency) 9r.Positioning/pressure relief routine—activity concerns • Lack of strength • Lack of equipment • Need help • Don’t want to ask for help • Don’t want to burden anyone • Forget/busy | Early mobilization (5.15) | Implement ongoing exercise program | Veterans who are more physically active are at lower risk for CAPrIs, as long as they are diligent in positioning | Veterans want to maintain a strong body through activity/exercise but may need assistance, not ask for assistance, or forget; Some Veterans do not have access to exercise facilities. |
Nutrition/ Eating habits | 9s.Nutrition/food concerns/issues • Knowledge of healthy eating • No access to healthy foods • Don’t like delivered food • Can’t prepare food • Eat fast/junk food • Difficulty chewing/ swallowing | Nutrition screening (4.1–4.3). Optimize energy intake for malnutrition (4.4–4.9), encourage adequate hydration (4.13) | Assess nutritional status and dietary intake and anthropometric measurements and biochemical parameters; fluid intake | Higher risk: dehydrated, obese, eat low nutrient food, lack access to healthy foods; Education: high protein, well hydrated; Resources as available | Veterans value a strong body; Diet supports a strong body; Some Veterans do not have access to healthy meals or finances for healthy meals. |
Caregiver Resource | 9t.Caregiver (agency) • Adequate hours • Scheduling hours • Correct care • Treated with respect/dignity | None | Caregivers needed; Veteran to direct caregiver; Caregiver education in prevention protocol | Providers order agency hours and required care; Providers troubleshoot when quality, scheduling or behavior issues arise | Veterans receive agency caregiving from VA, state agency and self-funding; Veterans require additional caregiving services |
Family Resource | 9u.Caregiver (family) • Family ability • Adequate time • Need more help • Get along • Correct care | None | Lacking access to care, services and supports increases risk | Family barriers (unavailable or unable to provide care); Limitation in family/caregiver resources | Family provides physical and emotional support; Families need education; Community informal support |
Environ-ment | 9v.Home environment (concerns) • falling • bump into things • difficulty navigating in my home • bathroom is too small • feel unsafe in my home • need help with general housekeeping • difficulty getting outside 9w.Neighborhood or outside environment concerns • falling • feel unsafe | None | None | None | Barriers in the home Environmental barriers |
Social | 9x.Life activities that make it difficult to prevent CAPrIs. • family/social event • sports • occupation/work • volunteer • travel | None | None | Social activities can create high risk situations. | Living life is important Forget pressure relief Stigma in prevention practices |
Access to healthcare | 9y.Difficulty coordinating healthcare needs • among VA providers in the VA SCI clinic • between the VA SCI clinic and my VA non-SCI primary care provider • between the VA SCI clinic and the community caregiving agency • between the VA SCI clinic and my VA specialty doctors • between the VA SCI clinic and my doctors outside the VA | None | None | Providers coordinate care | Barriers to caregiving services Travel/distance is a barrier Providers address acute medical issues. |
Coping | 9z.Coping (strategies) • Keep a positive attitude • Accept limitations and help • Focusing on living life • Engage in comfort activities • Engage in spiritual/religious practices • Advocates for self and others | Assess quality of life, provide psychosocial support (22.1, 22.2) | None | None | Coping provides the emotional strength to engage in CAPrI prevention. |
Health behaviors/engagement |
Substance use (tobacco, alcohol, other) | 10.Do you use tobacco products (smoke, vape or chew)? If yes, I am interested/not interested in discussing smoking cessation today 11.Do you drink alcohol (e.g., beer, wine, liquor)? If yes, calculate CAGE or AUDIT-C score 12.Do you take or smoke substances not prescribed by your provider? | None | Substance abuse, tobacco-use increases risk | Veterans should not smoke, drink alcohol or take substances not prescribed by the provider. | |
Provider engagement | 13.Are there things your provider can do to help you prevent pressure injuries? • No • Yes, I would like to talk about this in more detail with my provider today • Unsure, but I would prefer not to talk about this in more detail with my provider today | None | Initial comprehensive physical, functional, psychological, and nutritional assessment | Care coordination Education Maintain relationship Availability | Preventive care education post initial injury; Coordinate equipment, supplies, medication; Manage chronic conditions |
Veteran involvement in CAPrI prevention | 14.How involved would you like to be with pressure injury care? • Very involved. I want to partner with my provider in problem solving. • I have ideas I want to share about preventing pressure injuries. • I’m Ok with what my providers recommend. • I want to follow my own plan to prevent pressure injuries. I know what works for me. | Assess quality of life, self care, and knowledge. Provide education, skills, training, (22.1, 22.2) | Report skin changes to provider; Commit to preventive activities; Empowerment | Veterans need to be receptive to education Veteran needs to contact provider and be seen in clinic if they believe they have a CAPrI | Veterans view themselves as a resource and are motivated to prevent pressure injuries; Veteran knows their own body in CAPrI prevention; Veteran will figure out how to address CAPrI issue before contacting provider. Negative Provider-Veteran relationships affect Veteran engagement. Many Veterans advocate for their own and other Veteran’s needs. |