Clinical update

Pressure ulcer toolkit: advice for nurses on prevention and care pathways

Pressure Ulcer Prevention Advisory Board resource highlights the importance of risk awareness

Pressure Ulcer Prevention Advisory Board resource highlights the importance of risk awareness

Training a caregiver to spot signs of pressure sores
Picture: David Gee

Essential information

Pressure ulcers continue to challenge healthcare professionals and cause serious harm to many patients.

All patients are potentially at risk, but those with restricted mobility, cognitive impairment or palliative care needs are especially vulnerable.

In the NHS in England in the year to March 2016, nearly 25,000 patients developed a new pressure ulcer.

In 2014, the National Institute for Health and Care Excellence (NICE) said the daily cost of treating a pressure ulcer, including nurse time, dressings and diagnostic tests, ranged from £43 to £374, on top of standard care costs. 

Pressure ulcers can be painful and can seriously affect quality of life. Complications, such as infection, are common and can have life-changing consequences.

Many pressure ulcers are preventable and in recent years there have been several initiatives to reduce the risk, but the success of such initiatives can be hampered by variations in local implementation.

What’s new?

The Pressure Ulcer Prevention Advisory Board, whose members include expert nurses, has produced a booklet that brings together pressure ulcer prevention information.

The booklet also provides an algorithm to be used with local policies to form preventative care pathways.

The document highlights how small changes in health, such as a chest infection, can trigger a pressure ulcer. It says that caregivers may be unaware of the importance of such ‘seemingly insignificant’ events.

‘Risk awareness needs to be timely in order to limit harm,’ it says.

Alternative approaches to pressure ulcer prevention are emerging and technology is playing a part, the advisory board says.

For example, proactive assessment using devices that detect microcellular changes in the skin can help identify the early onset of a pressure ulcer, before it is visible to the naked eye.

Once the risk of pressure ulceration is evident, a clear care pathway that includes elements of self-management and specialist care should be followed, the information booklet says.

More essential clinical updates

Implications for nurses

Specialist nurses have long been integral to the management and treatment of pressure ulcers but all nurses have a role in prevention – from working with patients to maximise their mobility to educating unpaid caregivers.

The Pressure Ulcer Prevention Advisory Board points out that with care delivery moving closer to the patient’s home, informal carers play a critical role as the ‘eyes and ears’ of clinical staff. ‘However, this does depend on them understanding the importance of what they are seeing,’ the board says.

Vigilance is essential in pressure ulcer prevention, and skilled assessment of a patient’s risk of developing a pressure ulcer must be followed up with appropriate action, in line with NICE guidance on prevention and management.

Expert comment

Alison Schofield, tissue viability clinical nurse specialist, North Lincolnshire and Goole NHS Foundation TrustAlison Schofield, tissue viability clinical nurse specialist, North Lincolnshire and Goole NHS Foundation Trust, and member of the Pressure Ulcer Prevention Advisory Board says:

‘Superficial pressure ulcers can cause more pain than severe ones because nerve endings are more exposed. That leads to increased medication, which in turn can have side effects.

'Pressure ulcers often come with odour because the tissue is essentially dying and that can cause a major impact because people become embarrassed. They may then become isolated if they don’t want to mix with other people.

'But we’re becoming more aware. It may seem that we have more pressure ulcers now but it’s probably that we’re better at identifying and reporting them, although there’s still a lot more we can do.

‘Pressure ulcers are everybody’s business. It’s the absolute basics of care that matter, such as checking the skin and repositioning patients correctly. We’re not asking people to become tissue viability nurses, just to have an awareness of those at risk.'

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