Pressure ulcers

Some people are at higher risk of developing pressure ulcers than others.

Answer this question - are any of these statements true for anyone I support? If so, they might be at risk of developing a pressure ulcer.

• impaired mobility or spend a lot of time in the same position such as sitting or lying down

• incontinent or regularly have wet skin

• reduced feeling in any part of their body

• wouldn’t be able to tell anyone about any discomfort, itchiness or pain

• delicate or thin skin

• poor diet or don’t drink enough water

• recovering from an illness or surgery, which may impact on mobility or other risk factors

• repetitive behaviours, such as rocking or rubbing objects which put pressure on area(s) of their body

• other risk factors, think about how long they have part of their body in contact with other things like glasses, hearing aids, oxygen masks, wrist bands for alarm call buttons or TV remote controls.

There are different classifications of pressure ulcers - stage one might only be noticeable as very subtle changes in a person's skin. 

Resources to help

• Who is at risk poster (Love Great Skin) - this A4 poster explains who's at risk of pressure ulcers.

• Pressure ulcers trigger form (React to Red Skin) - this form will help you assess if someone's at risk of pressure ulcers.

• Download this pressure ulcers classification tool to help (from 3M Skin Care Products)

If you support someone with personal care look out for:

• part of the skin becoming discoloured (people with pale skin tend to get red patches, while people with dark skin tend to get purple or blue patches)

• discoloured patches not turning white when pressed

• a patch of skin that feels warm, spongy or hard

• pain or itchiness in the affected area.

Any of these could be early signs of a pressure ulcer and the person should contact their GP or nurse.

Get medical advice immediately if someone has: 

• red, swollen skin

• pus coming from a pressure ulcer or wound

• cold skin and a fast heartbeat

• severe or worsening pain

• confusion that’s unusual for them; a change to their usual level of understanding and/or behaviour

• a high temperature (fever) of 38C (100.4F) or above.

Resources to help

• Skin inspection guide (Love Great Skin) - this single sided guide will help workers do an inspection of someone's skin to see if there are any signs of pressure ulcers.

Simple things people can do to reduce the risk of developing pressure ulcers – they might be able to do it themselves or you could support them.

People should:

• regularly change position and move as much as is possible for them – for example walking around, doing stretches or sitting in different chairs throughout the day

• check their skin every day for early signs and symptoms of pressure ulcers

• have a healthy, balanced diet that contains enough protein, a variety of vitamins and minerals, particularly vitamin C and zinc, and enough to drink – if they have any concerns, ask their GP or healthcare team for a referral to a dietician

• ensure they dry their skin thoroughly after washing, but without vigorous rubbing or dragging the towel across the skin

• be careful moving or being moved to ensure their skin isn’t dragged - get advice from a physiotherapist or occupational therapist who may recommend lifting aids or slide sheets

• stop or cut down on smoking – it can restrict blood circulation

• get advice from a GP or nurse about whether they need prescribed creams or sprays to protect their skin – particularly people who need continence support.

Resources to help

The Love Great Skin campaign has posters and factsheets to help you prevent pressure ulcers, including:

• Support me

• Keep me moving

• Improve my skin

• Feed me well

• How to guides

As an employer you have a number of responsibilities for the people you support.

• Ensure that you and your staff:

  • know the risk factors and early signs of pressure ulcers, and how to prevent them
  • understand where and how to raise concerns
  • understand where to find information in people’s care plans, and record changes in skin condition.

• Be aware of your local safeguarding procedures about pressure ulcers. Know who to seek advice from and report concerns to in your area.

• Make information available to people using your service, staff and family carers in a way that they can understand.

• Ensure preventative actions are in place for everyone who’s at risk.

• Where a pressure ulcer is a safeguarding concern, take a multi-agency approach with your local authority, with health taking the lead for the clinical investigation.

Resources to help

• Safeguarding adults protocol: pressure ulcers and the interface with a safeguarding enquiry (Jan, 2017)

This guidance helps managers and practitioners to provide caring and quick responses to people at risk of developing pressure ulcers. It also offers a process for clinical management where ulcers occur, considering if an adult safeguarding response is necessary.