Therapist Name:
Therapist Email:
Client Name:
Contact Number: Date:
Funding Body (if applicable):
Client Address:
Bed Requirements
Headboard styles
The Oxford
Footboard
The Belgrave
Accessories
Self-help pole (BZ0325)
Battery back up system (BZ0335)
3/4 length horizontal side rails (BZ0302)
Nurse control panel (BZ0337)
Pressure Risk Assessment Criteria: (Rate each from 1–4) Granite
Telescopic 4 part side rail (BA6410)
Under bed light (BZ0336)
This algorithm is meant as a guide, not a substitute for clinical judgment. It should be used only as an adjunct to a full patient assessment and should not preclude the use of any product positioned higher in the algorithm. The pressure injury risk assessment tools suggested in this algorithm should not supersede clinical judgment, nor should they be considered a stand-alone indicator for implementing pressure relief devices.
1
Pressure Risk Assessment Criteria:
Severe Risk: Total score ≤9
Moderate Risk: Score 13–14
Does the patient have multiple Stage 3/4/UNS* Pressure Injuries2 (Other than on the heels)?
Does the patient have multiple Stage 2 or single Stage 3/4/UNS* Pressure Injuries2 (Other than on the heels)?
High Risk: Score 10–12
Mild Risk: Score 15–18
15-18
Score
MF4000 Casero Luxury Comfort Mattress
MF2570 Vulcan Mattress (Single / King Single)
MF0800 Optimal 5-Zone Mattress (Single / Single Plus / King Single)
15-18 Mild Risk
13-14 Moderate Risk
10-12 High Risk
<9 Severe Risk
Is the pressure injury complex (Heavy exudate infection, delayed healing, poor nutrition etc)? Yes
MA1920 A4 CX20 (Single / King Single)
MA3570 IQ CX20
MA4120 MoviAir T4
MA3420 Span Care Convertible (Single / King Single)
MA3830 IQ Cirrus
MA0140 A4 Cirrus Single / Single Plus / King Single)
MA4050 MoviComfort C4
MA0030 Area Zone (Single / Wide Single / Single Plus)
MF2590 Custom Care Mattress (Single / King Single / Small Double)
MA4060 MoviComfort C3
Note:
1.In situations where positioning on the pressure injury cannot be avoided (e.g., the individual has multiple injuries on multiple surfaces), limit the amount of time the individual is positioned on the injury.
2.Heel injuries are di cult to heal and should be elevated o the bed. Consider using a heel manager.
3.Ultramax may also be appropriate for multiple Stage 2 or single Stage 3 pressure injuries, and Max, Plus, or Pro may be appropriate for single Stage 2 pressure injuries—based on a full assessment of skin status and the repositioning required, according to best clinical practice and judgment.