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Pressure Injury Recurrence Toolkit

An evidence-based toolkit for guidance of healthcare workers, patients and informal caregivers providing strategies for prevention of recurrent pressure ulcers/injuries among patients with spinal cord injuries.

The project is developed in collaboration with Wounds Australia.

About the toolkit

This EWMA & Wounds Australia toolkit is a comprehensive, evidence-based resource designed to support the prevention of pressure ulcers (PU) and pressure injuries (PI) and reduce recurrence in people living with spinal cord injury (SCI).

Developed by international experts, the toolkit provides practical guidance, tools and educational materials applicable across the entire patient pathway.
The materials cover three key care settings including acute hospital, rehabilitation and home and offers tailored materials for clinicians and other health care professionals, homecare providers, caregivers, patients and family members.

The resources include structured guidance, checklists, training materials and patient-friendly information supporting early detection, optimal care and long-term prevention.

This project was developed by EWMA in collaboration with Wound Australia by the following team:

  • Editor: Dimitri Beeckman (Belgium and Sweden)
  • Editor: Hayley Ryan (Australia)
  • Editor: Paulo Ramos (Portugal)
  • Author: Cátia Borges (Portugal)
  • Author: Susan Flavin (UK)
  • Author: Samantha Holloway (UK)
  • Author: Andrea Pokorná (Czech Republic)
  • Author: Knærke Søgaard (Denmark)

© 2026 European Wound Management Association (EWMA).

Pressure Injury Recurrence: An evidence-based toolkit providing guidance for healthcare professionals, patients, and informal caregivers, with strategies to prevent recurrence among individuals with spinal cord injury.

Editors: D. Beeckman, H. Ryan & P. Ramos.
Authors: C. Borges, S. Flavin, S. Holloway, A. Pokorná, & K. Søgaard.

Developed in collaboration with Wounds Australia.

All resources are freely available for download. Please feel free to print or share the resources unlimited for non-commercial purposes. For reuse purposes please ensure proper credit is made to the original source and copyright holder.

The toolkit is intended as a set of ‘living resources’ which are subject to regular updates or further development, to maintain a set of up-to-date and relevant resources. 

We invite you to send us your feedback and proposals that may help us improve the resources. Your feedback is highly appreciated!

Questions or comments can be sent to ewma@ewma.org 

HOSPITAL – ACUTE IN-PATIENT CARE
  • Implement PU/PI prevention measures immediate after the SCI before admission to hospital, and maintain them throughout hospitalisation, including during examinations, care and treatment.
  • Prioritise PU/PI prevention as PU/PI in the acute phase can delay rehabilitation and increase the risk of PU/PI recurrence.
  • Early transfer to specialised SCI rehabilitation facility reduces the risk of recurrent PU/PI.
REHABILITATION
  • Implement PU/PI prevention measures.
  • A multidisciplinary approach involving SCI-specialised team is recommended.
  • Educate people with SCI and their relatives in PU/PI prevention strategies.
  • Thorough planning of the transition is essential, and lifelong follow-up services, either in-person or via telemedicine, are recommended.
HOME – LONG-TERM CARE
  • Comprehensive discharge planning from hospital or rehabilitation centre is crucial for PU/PI prevention.
  • Implement PU/PI prevention measures.
  • Ensure necessary accommodation, home modifications, and timely access to required assistive devices.
  • Establish follow-up services with access to multidisciplinary SCI-specialised team.
  • Contact SCI-specialised healthcare professionals if local management is insufficient, complications arise, or specialised support is needed.

Resources and materials by type

EWMA-DEWU 2026 session recording: Preventing recurrence that matters: A person-centred approach across care settings

Explore how to address one of the most persistent challenges in wound care: pressure injury recurrence. This session from EWMA-DEWU 2026 presents a structured, person-centred approach to sustainable prevention, combining clinical insights, implementation strategies and patient perspectives.

The session includes perspectives on:

  • Why pressure injury recurrence is a critical issue, including its clinical burden and impact across care transitions and the patient journey.
  • The rationale and key elements of the EWMA Pressure Injury Recurrence Toolkit.
  • Implementation strategies for embedding the toolkit in different care settings.
  • Patient perspectives to support person-centred prevention.
  • Relevant outcomes, including patient-reported measures, to support shared decision-making and long-term impact.

Speakers: Hayley Ryan, Dimitri Beeckman, Paulo Ramos, Evelien Touriany, Andrea Pokorná.

Project supporters

The toolkit is kindly supported by:

Author group

  • Editor: Dimitri Beeckman (Belgium and Sweden)
  • Editor: Hayley Ryan (Australia)
  • Editor: Paulo Ramos (Portugal)
  • Author: Susan Flavin (UK)
  • Author: Samantha Holloway (UK)
  • Author: Knærke Søgaard (Denmark)
  • Author: Andrea Pokorná (Czech Republic)
  • Author: Cátia Borges (Portugal)

HOSPITAL – ACUTE IN-PATIENT CARE
  • Implement PU/PI prevention measures immediate after the SCI before admission to hospital, and maintain them throughout hospitalization, including during examinations, care, and treatment.
  • Prioritise PU/PI prevention as PU/PI in the acute phase can delay rehabilitation and increase the risk of PU/PI recurrence.
  • Early transfer to specialized SCI rehabilitation facility reduces the risk of recurrent PUPI.

 

 

 

REHABILITATION
  • Implement PU/PI prevention measures.
  • A multidisciplinary approach involving SCI-specialized team is recommended.
  • Educate people with SCI and their relatives in PU/PI prevention strategies.
  • Thorough planning of the transition is essential, and lifelong follow-up services, either in-person or via telemedicine, are recommended.

 

 

 

 

HOME – LONG-TERM CARE
  • Comprehensive discharge planning from hospital or rehabilitation centre is crucial for PU/PI prevention.
  • Implement PU/PI prevention measures.
  • Ensure necessary accommodation, home modifications, and timely access to required assistive devices.
  • Establish follow-up services with access to multidisciplinary SCI-specialized team.
  • Contact SCI-specialised healthcare professionals if local management is insufficient, complications arise, or specialised support is needed.

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Project introduction

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Introductions and epidemiology
About pressure injuries in people with SCI

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