In 2003, the Canadian Association of Wound Care (CAWC) funded a study to determine the extent of chronic wounds in Canada.

The results of the study, by Gail Woodbury and Pamela Houghton, indicated that the prevalence of pressure ulcers was 25% in acute care, 30% in non-acute care, 22% in mixed healthcare settings and 15% in community care. The mean prevalence overall was 26%.

As appalling as these figures are, they cannot even begin to address patient suffering, family anguish and clinician frustration. The presence of a pressure ulcer can significantly impair quality of life, result in pain, extend hospital stays and lead to deconditioning for patients who are bedridden for extended periods.

In some cases, the presence of a pressure ulcer can lead to death. Mortality rates are as high as 60% in the elderly with a pressure ulcer within one year of discharge from hospital.

The CAWC has created a programme to increase awareness about how pressure ulcers can be prevented and to provide the tools necessary to reduce the numbers of pressure ulcers in all types of settings across Canada.

The first phase has been a pilot programme to test materials, processes and outcomes. Five facilities/agencies are currently participating in the pilot. Once all phases of the pilot programme are complete at the end of September, an evaluation of the programme will take place and the programme will expand to a national programme in 2007.

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Facilities chosen as pilot sites reflect the reality of the challenges that face many sites across the country. Through the request for proposal (RFP) process sites demonstrated their willingness to initiate and sustain a change in the culture of practice throughout their facility, which in turn could lead to a reduction in the prevalence and incidence of pressure ulcers.

The prevention of pressure ulcers requires that everyone – including the patient where possible – be aware of the risk factors for the development of pressure ulcers and the actions required to prevent them.

“The prevention of pressure ulcers requires that everyone – including the patient where possible – be aware of the risk factors for the development of pressure ulcers and the actions required to prevent them.”

Obstacles to the application of the knowledge and awareness of pressure ulcer prevention must be identified and removed where practical. This is only possible through a fully realised team approach supported by facility administration – which is the foundation on which the Pressure Ulcer Awareness Programme (PUAP) is built.


The effort and energy of the so-called ‘champions’ have been crucial to the success of the programme in each pilot site. Each champion has been responsible for making sure the items in the toolkit are used appropriately in each facility, for adding to and customising the materials as necessary, and for providing feedback on all aspects of the pilot to the CAWC pressure ulcer awareness team.

The champion also acts as a ‘coach’ for the pressure ulcer prevention teams (which should include patients as well) in their facility. As coaches they have been enthusiastic, positive, knowledgeable and accessible.

In addition, they have formed a support group, along with the CAWC PUAP team leader, where they can share suggestions, ask questions and work together to improve the programme for the next phase. Most importantly, the champions have been a key link with management in supporting and encouraging a culture shift that will move the focus from treating pressure ulcers to preventing them.