Evaluating Your Pressure Ulcer Prevention Plan: A problem-solving worksheet for people with spinal cord injury and their health care providers

      This worksheet will help people with spinal cord injury (SCI) identify challenges they face when trying to prevent pressure ulcers and work with their health care providers to address those challenges. Instructions and links to more information about preventing pressure ulcers are listed on the reverse side of this page.
      Tabled 1
      Pressure Ulcer Prevention TasksWhat Challenges Do You Face When Trying to Complete This Task?What Strategies Can You Use to Help Complete This Task More Effectively?
      Hygiene and Personal Care• Look at skin all over your body (using help from another person when needed to see all areas) for color changes, openings in the skin, or other signs of a pressure ulcer
      • Consult with a health professional (by phone, e-mail, or in person) right away if you observe signs of a pressure ulcer
      • Keep your skin clean and dry (including preventing bladder and bowel accidents)
      • Avoid tight clothes that pinch your skin
      Weight Shifting and Transfers• Shift your weight while seated
      • Shift your position in bed
      • Transfer from surface to surface without scraping or rubbing your skin
      Equipment• Use a cushion or padding designed to evenly distribute pressure on all places where you sit (wheelchair, shower chair, commode, car seat, floor, etc)
      • Use a mattress designed to shift pressure when lying down
      • Check your cushion/mattress for problems (such as a leak) or signs of wear and tear
      • Consult with a seating specialist periodically to evaluate whether any changes are needed in your wheelchair or cushion
      Nutrition and Health• Eat a healthy diet that includes the amount of protein recommended for you
      • Drink enough water to stay hydrated (signs of dehydration include thirst, dark-colored urine, and difficulty starting urine flow)
      • Maintain a healthy weight (as recommended by your doctor)
      • Do not smoke
      • Treat other medical conditions that may affect your circulation or how your skin heals (such as diabetes, heart problems)

      How to use this worksheet

      Health care providers

      • Present this worksheet to your patient/client as part of an education session or other interaction. Ideally, the worksheet should be presented after your patient/client has had an opportunity to try pressure ulcer prevention tasks at home so he/she will have sufficient experience to identify challenges.
      • Request that your patient/client complete the challenges column of the worksheet. This can be done during your education session or at home. (See subsequent instructions for people with SCI.)
      • Review the challenges your patient/client identified. Discuss possible strategies to address those challenges and help your patient/client complete the strategies column of the table.
      • Make sure your patient/client knows how best to reach you (or an appropriate alternative contact person) if he/she has questions about implementing the strategies you recommended.
      • Identify a date to evaluate the success of the strategies identified: ___/____/______.
      • Discuss how well the strategies worked and repeat the process of identifying challenges and finding solutions as needed.

      People with SCI

      • This worksheet is designed to help you prevent pressure ulcers.
      • For each task listed in the table, write in any challenges you may have when completing that task. These could include not being sure what is recommended for you, not knowing how to complete the task, difficulty getting the help you need from another person, lacking equipment necessary to complete the task, not having enough time, or other challenges.
      • Share this worksheet with your health care provider so that you can review the challenges you noted.
      • With help from your provider, identify steps you can take to address your challenges. These could include getting more information about how to do the task, practicing the task with feedback from your health care provider, arranging for additional help, getting additional equipment, changing your schedule, setting up alarms or other reminders to help you complete the task, or other strategies. Write those strategies in the table (or elsewhere if you prefer).
      • Find out how best to contact your health care provider (or an appropriate alternative contact person) if you have questions as you use the strategies discussed. Write that contact information here: _______________________________________________________________________________________
      • Schedule a date to speak with your provider about how well these strategies are working for you: ____/_____/_______.
      • Discuss how well the strategies worked and repeat the process of identifying challenges and solutions as needed.

      Pressure ulcer prevention resources for people with SCI

      We encourage you to speak to your health care providers about your risk for pressure ulcers and steps you can take to prevent pressure ulcers. Free guides are also available on the Internet from the following sources:
      • Model Systems Knowledge Translation Center (“Skin Care and Pressure Sores in Spinal Cord Injury”; available at:
      • Paralyzed Veterans of America (“Pressure Ulcers: What You Should Know – A Consumer Guide,” available via the “Publications” link at:


      Evaluating Your Pressure Ulcer Prevention Plan was developed by Jeanne M. Zanca, PhD, MPT, Patricia Heyn, PhD, Susan Horn, PhD, Susie Charlifue, PhD, C.-H. Jean Hsieh, PhD, OT, David M. Brienza, PhD, YuYing Chen, MD, PhD, Trevor Dyson-Hudson, MD, Deborah Backus, PhD, PT, and the Secondary Complications and Aging Task Force of the ACRM Spinal Cord Injury Interdisciplinary Special Interest Group. Support for its creation was provided by the National Institute on Disability and Rehabilitation Research (NIDRR) of the U.S. Department of Education via the Northern New Jersey Spinal Cord Injury System (grant no. H133N110020), Rehabilitation Engineering Research Center for Cognitive Rehabilitation (grant no. H133E090003), Rocky Mountain Regional Spinal Injury System (grant no. H133N110006), Rehabilitation Engineering Research Center on Spinal Cord Injury (grant no. H133E070024), National Spinal Cord Injury Statistical Center (grant no. H133A110002), and the Southeastern Regional Spinal Cord Injury Model System at Shepherd Center (grant no. H133N110005). Any opinions contained in this document are those of the authors and do not necessarily reflect those of the U.S. Department of Education or NIDRR.


      This information is not meant to replace advice from a medical professional. You should consult your health care provider regarding specific medical concerns and treatment.
      This Information/Education Page may be reproduced for noncommercial use for health care professionals to share with patients and their caregivers. Any other reproduction is subject to approval by the publisher.