Pressure ulcers (also known as pressure sores) are localised injuries to the skin and underlying tissue, usually occurring over bony prominences due to prolonged pressure. They are a significant cause of patient harm, leading to pain, infection, delayed recovery, and increased length of stay.
Pressure ulcer prevention is a key patient safety priority and requires a coordinated multidisciplinary team (MDT) approach. This article provides a practical overview of how pressure ulcers can be prevented on the ward, based on current NICE guidance and is the second article in our series on how a MDT approach can prevent harm and ensure best patient care.
Contents
Risk Factors for Pressure Ulcers
All patients are potentially at risk, particularly those with:
- Reduced mobility or inability to reposition
- Previous or current pressure ulcers
- Nutritional deficiency
- Cognitive impairment (e.g. delirium, dementia)
- Reduced sensation
- Moisture (e.g. incontinence)
All patients should undergo a documented risk assessment on admission, with reassessment if their clinical condition changes.
MDT Approach to Pressure Ulcer Prevention
Nursing Team
Nurses play a central role in prevention and monitoring.
- Perform regular skin inspections, especially over pressure areas
- Identify early signs such as non-blanching erythema
- Reposition patients regularly and document frequency
- Maintain skin hygiene and manage moisture (e.g. incontinence care)
- Implement individualised care plans
Physiotherapy and Occupational Therapy
Focus on mobility and pressure redistribution.
- Encourage and support early mobilisation
- Assess need for positioning aids and equipment
- Advise on safe transfers and seating
- Reduce prolonged pressure through movement and positioning
Medical Team
Doctors address underlying medical contributors.
- Identify and treat acute illness (e.g. infection, delirium)
- Optimise hydration and nutrition
- Ensure risk assessments are completed and escalated appropriately
- Support overall care planning for high-risk patients
Pharmacy and Dietetics
Support optimisation of patient factors.
- Pharmacists review medications contributing to immobility or sedation
- Dietitians assess and manage nutritional deficiencies where present
Key Preventative Measures
Repositioning
Regular repositioning is essential to relieve pressure.
- At-risk patients: reposition at least every 6 hours
- High-risk patients: reposition at least every 4 hours
- Use appropriate equipment if patients cannot reposition independently
Skin Assessment and Care
- Inspect skin regularly for early damage
- Pay attention to colour changes, temperature, and moisture
- Avoid massage or rubbing, as this can cause further damage
Pressure-Relieving Equipment
- Use high-specification foam mattresses for at-risk patients
- Consider pressure-relieving cushions for those sitting for prolonged periods
- Offload pressure from high-risk areas (e.g. heels)
Nutrition and Hydration
- Ensure adequate nutrition and hydration
- Only provide supplements if a deficiency is identified (not routinely for prevention)
Moisture and Skin Protection
- Manage incontinence effectively
- Consider barrier creams in patients at risk of moisture-related skin damage
Individualised Care Planning
Patients at high risk should have a documented, individualised care plan that includes:
- Risk assessment findings
- Repositioning schedule
- Equipment needs
- Comorbidities and patient preferences
Key Principles
- Pressure ulcers are largely preventable with early intervention
- Risk assessment and regular reassessment are essential
- Repositioning and pressure redistribution are the cornerstone of prevention
- Prevention requires a coordinated MDT approach
- Early recognition of skin changes can prevent progression to severe injury
Further Reading
- NICE Guideline CG179: Pressure ulcers – prevention and management
- Read our Mind The Bleep Article on Pressure Ulcer Management
Written by Dr S Dhaliwal (SHO)
Reviewed by Dr A Sidhu (CT2)
