Policy briefing

NHS Improvement guidance calls for consistent approach to pressure ulcer definition and measurement

Guidance calls for the 72-hour rule for pressure ulcers to be scrapped

Guidance calls for the 72-hour rule for pressure ulcers to be scrapped

NHS Improvement says lack of national guidance on defining pressure ulcers has led to inconsistency. Picture: SPL

Essential facts

Almost 1,300 new pressure ulcers are reported each month in the NHS in England, according to NHS Digital.

Expert comment

Jennie Hall

Jennie Hall is strategic nursing adviser at NHS Improvement


‘This guidance has been written with front-line staff to support a consistent approach to the type of pressure damage being reported so that organisations can learn from incidents and implement quality improvement activity.

‘Understanding what type of pressure ulcer harm has occurred in a clinical area, or at a divisional or trust level, supports quality improvement.

‘Each organisation has been asked to review its reporting practice, make changes as required and implement the recommendations by April to reduce the level of harm patients experience.

‘Pressure ulcers are an indicator of the quality and experience of patient care. Preventing them will improve care for all patients.’

Treating pressure damage costs the NHS more than £3.8 million every day, but the recording of pressure ulcers and their severity can vary within and between trusts.

Finding ways to improve the prevention of pressure damage is therefore a priority for policymakers, managers and healthcare staff.

What’s new?

The recommendations set out by NHS Improvement’s Stop the Pressure campaign are intended to improve the understanding of pressure ulcer harm, and help organisations reduce pressure damage and improve quality of care.

Lack of national guidance on defining pressure ulcers and their severity has led to inconsistency, NHS Improvement says, and all trusts in England should adopt a consistent approach to defining, measuring and reporting pressure ulcers from April 2019.

The guidance, called Pressure Ulcers: Revised Definition and Measurement Framework, should also help raise awareness of ‘hidden’ deep pressure damage such as deep tissue injury and pressure damage caused by medical devices.

The recommendations include always using the term ‘pressure ulcer’ and referring to those related to medical devices as ‘medical device-related pressure ulcers’. The term ‘Kennedy ulcer’, sometimes used at the end of life due to skin failure, should not be used.

The term ‘avoidable’ should no longer be used when recording a pressure ulcer and the so-called 72-hour rule should be scrapped, the guidance states.

To improve consistency, the term ‘category’ should be used in all national and local documents to refer to the severity of a pressure ulcer. The guidance sets out the internationally agreed categories of pressure ulcer severity that should be used.

Implications for nurses

  • The Department of Health and Social Care’s definition of avoidable and unavoidable pressure ulcers should no longer be used
  • All incidents should be investigated and all pressure ulcers, including those considered unstageable, avoidable or unavoidable, should be incorporated in local pressure ulcer monitoring
  • The '72-hour rule', which states that a pressure ulcer spotted within 72 hours of the patient’s admission is attributable to the admitting organisation, should be abandoned due to the complexity of patient pathways
  • Moisture-associated skin damage should be counted and reported in addition to pressure ulcers
  • Organisations should follow the international classification system, incorporating categories I, II, III and IV, deep tissue injury and unstageable ulcers (National Pressure Ulcer Advisory Panel 2014)
  • NHS safety thermometer data collection should continue monthly in all trusts to aid understanding of pressure ulcers and other issues in local clinical settings


Find out more

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