PHILIPPINE HEART CENTER

East Avenue, Quezon City

Name: __________________________________________ Unit:___________________

Immediate Supervisor: ____________________________ Date:___________________

Pressure Ulcer Care

Legend: CD – Correctly Done; ID – Incorrectly Done

Date: Date: Date:
CRITICAL CARE COMPETENCIES
CD ID CD ID CD ID
PREPARATORY PHASE:
1. Identifies the grading of bedsores
2. Checks the prescribed management of wound
3. Explains the procedure to the patient and significant others
4. Provides privacy and proper lighting
5. Places trash can within easy reach
6. Performs hand hygiene properly
7. Assembles all necessary materials at the bedside
PERFORMANCE PHASE
8. Positions patient comfortably, with area of the wound exposed
9. Dons clean gloves
10. Loosens tape by holding skin and peeling back the edges
slowly
11. Moisten the dressing using saline
12. Grasps a corner of the edge of the dressing rolls it back and
remove it
13. Folds dressing inwards on itself and disposes in the trash can
14. Assesses wound characteristics
15. Performs hand hygiene properly
16. Opens dressing kit
17. Dons a sterile gloves
18. Washes inside and around the wound if dead tissues or
foreign debris are present
19. Gently irrigates wound with normal saline using syringe
20. Blots the wound dry with a sterile gauze pad or clean cloth
21.Applies antiseptic agents or topical antibiotics, as ordered,
using a cotton tip applicator directly to the base of the wound
a. (For wound with irregular shape: firmly stroking from
center outward with circular motion)
22. Applies the primary dressing keeping the wound moist but
not too wet.
 Date: Date: Date:
CRITICAL CARE COMPETENCIES
CD ID CD ID CD ID
23. Applies the secondary dressing (dry gauze) to fasten the
primary dressing tightly to the body
FOLLOW-UP PHASE
24. Evaluates patient's response to the procedure
25. Discards all waste materials as per hospital policy
26. Performs hand hygiene properly
27. Documents clinical findings in appropriate forms
28. Updates physician of the characteristics of the wound

1. Clinical Evaluator: ______________________________ Date: _____________________

Signature Over Printed Name

Remarks: __________________________________________________________________________________
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2. Clinical Evaluator: ______________________________ Date: _____________________

Signature Over Printed Name

Remarks: __________________________________________________________________________________
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3.Clinical Evaluator: ______________________________ Date: _____________________

Signature Over Printed Name

Remarks: __________________________________________________________________________________
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