Clinical update

Pressure ulcers

About 700,000 people in the UK develop pressure ulcers every year.

Essential facts

About 700,000 people in the UK develop pressure ulcers every year. Previously known as pressure sores or bed sores, they are preventable in about 95% of cases, according to the NHS Stop the Pressure campaign. Each one costs an average of £4,000 to treat. The National Institute for Health and Care Excellence (NICE) advises that these wounds can lead to life-threatening complications such as blood poisoning and gangrene.

Picture credit: SPL

Every patient admitted to a hospital or a care home with nursing staff should have a pressure ulcer risk assessment within six hours, according to a new quality standard from NICE.

The standard aims to reduce the number of people developing pressure ulcers in all settings, prevent lengthy hospital stays and improve patients’ quality of life. It states that people with a risk factor for pressure ulcer development who are referred to community nursing services should have this risk assessment at the first face-to-face visit.

Pressure ulcers are caused by damage to an area of skin and/or the tissues below as a result of pressure or distortion sufficient to impair blood supply, according to NICE. They often occur in people confined to a bed or chair for long periods due to illness.

NICE says that all people are potentially at risk of developing pressure ulcers, but they are more likely to occur in those aged over 75 and in people who are seriously ill, have a neurological condition, impaired mobility, poor posture, compromised skin or are malnourished. People are also at risk if they have significant loss of sensation, a previous or current pressure ulcer or are unable to reposition themselves.

NICE guidance published in 2014 says that clinical staff should assess and document pressure ulcer risk using a validated scale to support clinical judgement, such as the Braden scale or Waterlow score. People considered to be at risk should have a skin assessment which, in adults, should take into account any pain or discomfort, skin integrity in areas of pressure, colour changes or discoloration, and variations in heat, firmness and moisture, according to the new quality standard.

Expert comment

Mark Collier, nurse consultant for tissue viability at United Lincolnshire Hospitals NHS Trust

‘Pressure ulcers have an impact on all aspects of a patient’s quality of life. The increasing number of older people means there are more people at risk of developing pressure ulcers. While much of the quality standard may be met in hospital and community settings, there may not be as much awareness or training in care homes.

‘All nurses should be using the SSkIN bundle. The five elements of SSkIN are: support surface requirements; skin inspection; keep patients moving; incontinence/moisture management; and nutrition and hydration assessment. Prevention from day one is the way forward, so that fewer pressure ulcers develop.’

Find out more

NICE pressure ulcer quality standard (June 2015)

NICE pressure ulcer guidance (April 2014)

Wounds UK best practice statement (June 2013)

SSkIN bundle: five simple steps to prevent and treat pressure ulcers

Documentation and record keeping in pressure ulcer management

Engaging patients in pressure ulcer prevention

Preventing pressure ulcers in patients in intensive care

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