Pressure ulcers develop quickly, hurt considerably and take months to heal, yet the great majority are preventable with routine attention. If someone spends long periods in a bed or chair, this is one of the most valuable things a family can get right. This guide sets out what to do daily and what to escalate.
Sustained pressure on skin over a bony area restricts blood flow and the tissue begins to die. Friction and shear, such as sliding down a bed rather than being lifted clear, make it worse, and moisture from perspiration or incontinence weakens the skin still further.
Damage can begin within a couple of hours in a frail person. That is why repositioning schedules matter more than any cream, and why an afternoon in an unsuitable chair can undo a week of good care.
Risk rises with immobility, poor nutrition, dehydration, incontinence, diabetes, poor circulation, previous pressure damage and very thin or very heavy body weight. Anyone who cannot reposition themselves independently should be treated as at risk by default.
Formal risk assessment tools are used by district nurses, and any care plan should record the risk level, the repositioning interval and the equipment in use.
Heels and the sacrum, the base of the spine, account for a large share of pressure ulcers. Also check the hips, elbows, shoulder blades, ears, the back of the head and, in seated people, the sitting bones.
Check skin at least daily, and at every personal care visit for anyone at higher risk. Look for redness that does not blanch when pressed lightly, and for any area that feels warmer, cooler, firmer or boggier than the surrounding skin. On darker skin, colour change is harder to see, so rely more on temperature and texture and on the person reporting pain.
Reposition according to the assessed schedule, commonly every two to four hours in bed and hourly for someone seated for long periods. Use slide sheets rather than dragging, and use pillows to offload heels completely rather than relying on a cushion under the calf alone.
Pressure relieving mattresses and cushions are provided free following assessment in most areas. A dynamic alternating mattress is used for higher risk, but it does not remove the need to reposition, which is a common and costly misunderstanding.
Keep skin clean and dry, use a pH balanced cleanser rather than soap, pat rather than rub, and apply barrier products only where advised. Never massage a reddened area, because it increases tissue damage.
Protein, calories, vitamin C, zinc and fluids all matter for skin integrity and healing. Poor intake is a genuine driver of pressure damage, so weight loss or reduced appetite should be reported and reviewed, and fortified diets or supplements discussed with the GP or dietitian.
Contact the district nurse the same day for any non blanching redness, blister, broken skin or unexplained pain over a bony area. Pressure ulcers graded two and above need formal nursing assessment and dressing, and the district nursing team leads that care.
Our carers carry out skin checks at personal care visits, record what they see and escalate rather than wait. Where someone is at high risk, live-in or overnight care ensures repositioning actually happens through the night, which is when schedules most often slip.
In a frail person, tissue damage can begin within a couple of hours of unrelieved pressure, which is why repositioning schedules matter so much.
Commonly every two to four hours in bed and around hourly when seated, but follow the schedule set in the nursing assessment.
No. Pressure relieving mattresses reduce risk but do not replace repositioning, skin checks and good nutrition.
No. Massaging reddened skin over a bony area increases damage. Relieve the pressure and report it to the district nurse.
In most areas yes, following assessment by a district nurse or occupational therapist.
Yes. Skin checks are recorded at personal care visits and anything concerning is escalated to the district nurse the same day.
Trained carers, recorded skin checks, NHS liaison. Call 01784 740078.
Trained carers, recorded skin checks, NHS liaison. Call 01784 740078.
