Pressure ulcers

Pressure ulcers are damage to the skin and the tissue underneath it, as a result of prolonged pressure. They usually develop on skin that covers bony parts of the body such as heels, ankles, tailbone and hips. 

They can be extremely painful and even life threatening if left untreated. If they're a result of neglect, poor care or aren't treated properly, this can be a safeguarding issue.  

It's important that everyone working in adult social care, including front line care workers and managers, know about pressure ulcers and how to treat them. 

You might already have guidance in your organisation or from your local authority. But if not, we've brought together useful resources to help you and your workforce learn more. They explain who's at risk, what you need to look out for, how to reduce the risk and what your responsibilities are as an employer. 

Useful resources to help

If you support people who could develop pressure ulcers, this leaflet explains who’s at risk of developing pressure ulcers, what you need to look out for and how you can reduce the risk. It's aimed at front line care workers and you can use it in the workplace as a reminder and display the inside poster on your notice board.

The React to Red Skin campaign has lots of information, templates and case studies to help, including:

The Love Great Skin campaign, from NHS Midlands and North East, also has posters and factsheets, including:

  • Practical posters - to help you understand who's at risk and how to support people
  • How to guides - to help you support people who are at risk, for example by keeping skin health and people moving.

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.

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

  • They’re incontinent or regularly have wet skin

  • They have reduced feeling in any part of their body

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

  • They have delicate or thin skin

  • They have a poor diet or don’t drink enough water

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

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

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

Resources to help

 

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.

Here are some simple things that 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:

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

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.

 

If you or your workers want to know more about pressure ulcers, speak to your local authority in the first instance. They might have guidance to help you. 

There's also lots of information online such as the React to Red Skin campaign. 

Training is a great way to develop skills and knowledge. Find courses delivered by Skills for Care recommended learning providers on our  endorsed provider directory.

You may also be able to apply for funding to cover the cost of qualifications through our  Workforce Development Fund.