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Nurse’s alert system helps carers spot pressure ulcer warning signs

Personalised alert cards for patients, carers and family members give specific instructions on care and observations, and have helped reduce serious incidents related to pressure ulcers at a London trust

A tissue viability nurse specialist is hoping to improve carers’ awareness of pressure ulcers and potentially avoid life-altering injuries for patients.

Debbie Wickens of North East London Foundation Trust (NELFT) came up with the idea for a new alert system after working with a patient whose skin changes were not spotted early enough, leading to surgery and an eight-month hospital stay.


Debbie Wickens' work on pressure ulcer awareness has prompted her trust to begin offering education to carers. 

Personalised alerts

Ms Wickens created personalised alert cards for patients, carers and family members, with specific instructions on care and observations. 

Based on advice given to nurses by the Department of Health and Social Care in 2005, the cards use a traffic light warning system and point out vulnerable areas of the body.

They are now being used across NELFT, Barts Health NHS Trust and Barking, Havering and Redbridge University Hospitals NHS Trust.

The cards are part of a wider effort at NELFT, which has seen the number of serious incidents related to pressure ulcers in patients cared for by the community and mental health trust fall by 45% in the past two years.

Around 700,000 people a year in the UK are affected by pressure ulcers. The National Institute for Health and Care Excellence estimates treatment and care costs total £1.4-2.2 billion.

Spotted too late

Ms Wickens began her efforts to improve awareness after seeing the consequences for a patient in his forties who had a missed pressure ulcer.

‘The man, a wheelchair user, had his own flat, drove a car, worked as a volunteer in the local mobility centre. He had a full life and was independent, he just needed carers to get up and then get back to bed,’ she says.

A mark on his skin developed and was either not spotted by his carers or not recognised as a potential pressure ulcer. It later developed into a life-altering injury. 

Ms Wickens says the man is currently unable to live by himself and three years of his life have been ‘stolen’ from him.

‘From me seeing him, he went straight into hospital and remained there for eight months. I believe if we had seen him earlier, seen the skin changes, we would have recognised they were coming from seating.

‘We would have given him advice, got his seating reviewed, increased his bed rest. And it might not have happened – he might still be living the life he was.’

Online training

Ms Wickens’ work has prompted NELFT to begin offering education to carers, including online training.

But she says involving carers and their employers in training, even when it is free, has been a challenge.

She hopes pressure ulcer knowledge will become a mandatory part of the care certificate for carers developed by the charity Skills For Care, Health Education England and Skills for Health.

Along with others, she is also working with NHS Improvement to create a national pressure ulcers curriculum for all practitioners.


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