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.

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)