Beyond risk assessment: elements for pressure ulcer prevention.

Considerable emphasis has been placed on identifying individuals who are at risk for developing pressure ulcers. However, the generality of diagnostic discriminations and consequent intervention strategies may have resulted in less effective outcomes than otherwise would be possible. When such processes are carried out in a system devoid of the fundamental elements required for increased diagnostic/prescriptive precision and systematic improvement, practitioners are, at best, relegated to relying on external trial-based research to yield new "best practices." At worst, ineffective and costly practices continue without systematic evaluation and alteration. Several necessary elements of any empirically-based prevention system are addressed, and an attempt to integrate the elements into a system for field utilization is illustrated. If successful, the system will result in incremental improvements in the outcomes of prevention efforts over time.