Clinical update

Pressure ulcer prevention and treatment: guidance for nurses

International guideline on preventing and treating pressure ulcers includes skin protection, pain management and appropriate support surfaces
Picture shows two medics examining the skin on a patient’s feet. New international guidance on pressure ulcers includes protecting the skin, managing pain and choosing support surfaces.

International guideline on preventing and treating pressure ulcers includes skin protection, pain management and appropriate support surfaces

Essential facts

According to NHS Improvement a pressure ulcer is localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), which results from sustained pressure . The damage can present as intact skin or an open ulcer and may be painful.

NHS Improvement adds that pressure ulcers are a key indicator of the quality and experience of patient care . The management of pressure ulcers

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International guideline on preventing and treating pressure ulcers includes skin protection, pain management and appropriate support surfaces

Picture shows two medics examining the skin on a patient’s feet. New international guidance on pressure ulcers includes protecting the skin, managing pain and choosing support surfaces.
Skin assessment is vital in people at high risk of pressure injuries. Picture: Martin Ellard

Essential facts

According to NHS Improvement a pressure ulcer is localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), which results from sustained pressure. The damage can present as intact skin or an open ulcer and may be painful.

NHS Improvement adds that pressure ulcers are a key indicator of the quality and experience of patient care. The management of pressure ulcers remains a significant healthcare problem, with more than 1,300 new ulcers reported each month, according to the NHS. Pressure ulcers are often preventable.

What’s new?

The third edition of international guidance on avoiding and treating pressure ulcers – a collaboration between the European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel and the Pan Pacific Pressure Injury Alliance, along with 14 national wound organisations – provides recommendations on how to assess and protect the skin, the importance of assessing and managing pain and how to choose the correct support surfaces.

Signs and symptoms

In people at high risk of pressure injuries the skin should be assessed for erythema, temperature changes, oedema and moisture levels. There should also be a comprehensive pain assessment.

Causes and risk factors

All patients are potentially at risk of developing a pressure ulcer, according to the National Institute for Health and Care Excellence.

They are more likely to occur in people who are seriously ill, have a neurological condition, impaired mobility, impaired nutrition, poor posture or a deformity. The use of equipment such as seating or beds not specifically designed to provide pressure relief can cause pressure ulcers.

How you can help your patient

  • Consider the potential effects of older age on the risk of pressure injuries.
  • Use a structured approach to pressure injury risk assessment, include a comprehensive skin assessment, supplement the use of a risk assessment tool with assessment of additional risk factors and interpret the assessment outcomes using clinical judgement.
  • Conduct a comprehensive skin and tissue assessment for all patients at risk of pressure injuries as soon as possible after admission or transfer to a clinical setting, as part of every risk assessment and periodically as indicated by the individual’s degree of risk, as well as before discharge.
  • Implement a skin care regimen that includes keeping skin clean and hydrated, cleansing the skin promptly after episodes of incontinence, avoiding alkaline soaps and cleansers and protecting the skin with a barrier product.
  • Avoid rigorously rubbing skin that is at risk of pressure injuries.
  • Conduct nutritional screening for people at risk of pressure injury.
  • Reposition all individuals with, or at risk of, pressure injuries on an individualised basis unless contraindicated.
  • Consider a diagnosis of spreading infection in older adults with a pressure injury who exhibit confusion or delirium.

Expert comment

Picture of Zena Moore, head of the school of nursing and midwifery at the Royal College of Surgeons in Ireland and a member of the guideline governance group. She comments on new guidance on pressure ulcers.Zena Moore, professor and head of the school of nursing and midwifery at the Royal College of Surgeons in Ireland, co-chair of the European Pressure Ulcer Advisory Panel Scientific Committee and member of the guideline governance group

‘Pressure ulcers are a common and devastating problem. This international guideline on avoiding and treating pressure ulcers is a fundamentally important document for all those involved in the care of older people. It has been systematically developed through a rigorous process and provides robust information on the most important considerations in prevention and treatment.

‘Some new additions to the guideline include "Consider using a sub-epidermal moisture/oedema measurement device as an adjunct to routine clinical skin assessment” and “Use a soft silicone multilayered foam dressing to protect the skin for individuals at risk of pressure injuries.”

‘In terms of prevention, a good place to start is to consider if you are asking the right questions, for which you can use the mnemonic ASSKIN, in which A refers to risk assessment, S skin assessment and prevention, S the surface the individual is seated or lying on, K keep moving, I incontinence management and N nutrition.’


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