Pressure Ulcers - Understanding what went wrong through RCA and PSIRF
This session will consider investigating pressure ulcer incidents within the context of Patient Safety Incident Response Framework (PSIRF) and the new National Wound Care Strategy Recommendations.
Undertaking investigations within your care home or home care team will help you understand what improvements need to be made, if any, to the care being delivered. Demonstrating that this activity is taking place, being acted upon and improving pressure ulcer incidents could support an improved CQC rating.
Learning Outcomes
- Understand briefly how a pressure ulcer is caused
- Be aware of the relevant national documents that guide when to investigate.
- Understand the key actions for prevention
- Understand how to determine which factors led to the development of a pressure ulcer
Meet our Experts

Heidi has been a Tissue Viability Nurse since 2002. Her interest and passion in the prevention and management of pressure ulcers began, however, in 1987 on registering as a nurse. She has worked in both acute and community care.
People who watched this also watched...
Seating for Care Homes
This webinar introduces how seating can be used to help manage pressure, as well as functional needs of your residents. We explore the benefits of good seating and potential consequences of not providing adequate seating. There's an overview of what posture is and how it is linked to pressure management. We also discuss the potential barriers and possible solutions to the provision of seating in care homes
Link between lower limb oedema pressure ulcers and legrest elevation
Very often when caring for people with lower limb oedema we are advised to elevate the legs. Why is this and how does this help? This webinar will help you understand oedema, its reduction and how this can also help prevent heel pressure ulcers.
Building a strong foundation: Care principles and professional development for early career OTs
This session is aimed at Occupational Therapy students and new graduates who want to explore core principles of good care that will be guiding them as healthcare professionals. The session will touch on the four pillars of practice, the role of supervision and education, and the importance of continuing professional development throughout their careers. By the end of the session attendees should feel more confident about the foundations of care across a range of clinical settings.