Purpose-T: A Smarter Tool for Pressure Ulcer Risk

At Apex Experts, our work often intersects with the outcomes of tissue viability and wound care practices. When pressure ulcers arise due to lapses in assessment or inappropriate management, the consequences can be severe - not just for patients but also within the medico-legal arena.

For this reason, we advocate the use of PURPOSE‑T (Pressure Ulcer Risk Primary or Secondary Evaluation Tool) - a structured, evidence-based framework that supports both clinical excellence and legal defensibility.

What Is PURPOSE-T and Why It Was Created

PURPOSE‑T is not just another scoring system. Developed through a rigorous, multi-phase research initiative by the University of Leeds and the National Institute for Health Research, it blends systematic review, expert consensus, conceptual theory, pre-testing with clinical nurses, and full-scale clinical evaluation.

This solid foundation underpins its increasing adoption across hospital and community settings, with endorsement from the National Wound Care Strategy Programme and incorporation into continuing professional development offerings.

How PURPOSE-T Works: A Three-Step Approach

PURPOSE‑T's assessment process unfolds through three key stages:

1. Screening

All patients undergo an initial screening that evaluates mobility, skin condition, and allows for clinical judgment, such as considerations of medical devices or recent illness. The value here is precision: patients clearly not at risk, perhaps independently mobile with healthy skin, can bypass further detailed assessment, conserving staff time for those who need it most.

2. Full Assessment

   
   

If screening flags a risk, nurses proceed to a comprehensive evaluation. This examines independent movement, skin integrity, past ulcer history, presence of medical devices, circulatory and nutritional status, sensory perception, moisture exposure, and diabetes status. Such depth ensures a holistic risk profile rather than relying solely on numeric scoring.

3. Risk Stratification via Colour Coding

   
   

The final risk decision is clearly communicated through colour-coded outcomes:

Green: No current ulcer and low risk - no further action needed.

Amber: At risk - primary prevention required.

Red: Existing ulcer or scar - secondary prevention and targeted treatment needed.

This intuitive system encourages rapid visual comprehension and supports consistent clinical decision-making.

Advantages Over Other Assessment Models

Traditional tools like the Braden, Waterlow, or Norton scales depend on aggregated scores across multiple domains. While useful, these can dilute specific risk indicators and may not be intuitive in fast-paced care settings.

PURPOSE‑T stands out in several ways:

It integrates skin assessment into the core of risk evaluation, capturing early skin changes such as dryness or paper-thin texture - red flags often overlooked by numeric systems.

It empowers clinical judgment rather than replacing it with tick-box certainty - a critical distinction when patient scenarios defy rigid categorisation.

Its colour-coded format ensures that risk levels prompt clear action pathways without ambiguity.

Making PURPOSE-T Work in Clinical and Legal Contexts

Clinicians value PURPOSE‑T for its clarity and practicality, especially when fast and accurate pressure ulcer prevention matters.

From a medico-legal perspective, however, PURPOSE-T offers more:

• It provides a defensible audit trail by linking identification of risk factors directly to action pathways.

• It helps pinpoint when escalation should have occurred and whether care met accepted standards.

• Expert witnesses referencing PURPOSE-T-aligned assessment can ground causation arguments in structured and documented clinical reasoning.

Conclusion: Why PURPOSE-T Matters

PURPOSE-T is a powerful fusion of evidence-based assessment and thoughtful design. It redefines how pressure ulcer risk is identified and managed, embedding clarity without compromising clinical nuance. For healthcare professionals, it elevates preventive care. For medico-legal practitioners, it offers a transparent scaffold supporting both breach and standard-of-care assessments.

If your case involves tissue viability concerns, pressure ulcer management, or wound care litigation, incorporating PURPOSE-T as part of your expert evidence framework can be transformative. Our panel at Apex Experts can assist with analysis, reporting, and strategic case preparation.