SCOPE OF THIS CHAPTER

This applies to the care of anyone who may be prone to pressure ulcers.

1. Principles

Pressure ulcers are entirely preventable and are not an inevitable part of life for people with high levels of dependency. A pressure ulcer is an area of localised damage to the skin and underlying tissues caused by pressure, shear or friction and can have a profoundly negative effect on quality of life.

2. Procedural Steps

Step Action By Whom
1. A person’s potential to develop pressure ulcers is increased by the following factors:
  • Reduced mobility;
  • Incontinence;
  • Acute illness or infection;
  • Reduced level of consciousness;
  • Extreme age;
  • Vascular disease;
  • Sensory impairment;
  • Malnutrition or dehydration;
  • Previous history of pressure damage;
  • Inadequate care.

If someone has one or more of these factors present, a risk assessment should be carried out and a pressure ulcer prevention plan developed. The person’s support plan should be amended accordingly.

Keyworker overseen by senior staff member
2. NICE Guidelines: Pressure Ulcers – Prevention and Treatment state that everyone identified as being at risk of developing pressure ulcers and their carers should receive advice and education in pressure ulcer prevention and treatment. This should include:
  • Risk factors;
  • Sites where ulceration most commonly occurs;
  • How to inspect skin and recognise skin damage;
  • Techniques for inspecting skin;
  • Skin care;
  • Methods of pressure reduction and relief;
  • The use of pressure relieving devices and equipment;
  • Trouble shooting problems with equipment;
  • Where to access further help and advice.

Key staff who manage or provide care to people who are vulnerable to pressure ulcers should therefore receive advice and training in the above areas.

Multidisciplinary team/ HCC training section
3. People must be kept as dry from urine as possible. If someone has problems with continence, this must be addressed in their support plan. Care staff
4. People with reduced mobility must be assisted to change their position regularly during the day and must be turned regularly during the night. A referral should be made to the occupational therapy service for assessment for equipment which may help with this. Care staff
5. If someone is eating and drinking little, staff must be vigilant and take care that the person does not become malnourished or dehydrated. Care staff
6. Although pressure ulcers can develop on any part of the body, the most common areas are the sacrum, buttocks or heels. Regular inspections of skin should be carried out, the frequency informed by the level of risk to the person. Signs of the onset of pressure damage include:
  • Persistent reddening;
  • Skin doesn’t go white when you touch it;
  • Blisters;
  • Discolouration;
  • Localised heat;
  • Localised oedema;
  • Abnormal hardening of the skin.

If any of these are present, advice should be sought from the person’s GP or District Nurse.

Care staff
7. Progress on the condition must be carefully monitored and if the condition worsens or the skin breaks, further medical advice must be sought immediately. Senior staff member