Pressure ulcers: prevention and management

Introduction

Pressure ulcers are caused when an area of skin and the tissues below are damaged as a result of being placed under pressure sufficient to impair its blood supply. Typically they occur in a person confined to bed or a chair by an illness and as a result they are sometimes referred to as 'bedsores', or 'pressure sores'.

All patients are potentially at risk of developing a pressure ulcer. However, they are more likely to occur in people who are seriously ill, have a neurological condition, impaired mobility, impaired nutrition, or poor posture or a deformity. Also, the use of equipment such as seating or beds which are not specifically designed to provide pressure relief, can cause pressure ulcers. As pressure ulcers can arise in a number of ways, interventions for prevention and treatment need to be applicable across a wide range of settings including community and secondary care. This may require organisational and individual change and a commitment to effective delivery.

Pressure ulcers are often preventable and their prevention is included in domain 5 of the Department of Health's NHS outcomes framework 2014/15. The current guideline rationalises the approaches used for the prevention and management of pressure ulcers. Its implementation will ensure practice is based on the best available evidence. It covers prevention and treatment and applies to all people in NHS care and in care funded by the NHS.

Recommendations for prevention include methods for identification and risk assessment and the preventive measures that should be applied. Treatment of pressure ulcers includes recommendations on wound care, adjunctive therapies and support surfaces. While there is much clinical expertise and good practice focused on preventing and treating pressure ulcers, it is hoped that this evidence-based guidance will contribute to reducing the number of pressure ulcers nationally through its implementation throughout the NHS.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.

See also the NHS Improvement revised definition and measurement framework for pressure ulcers. This will help deliver a consistent approach to defining and measuring pressure ulcers, and help to understand the level of pressure damage harm in England.

Safeguarding children

Remember that child maltreatment:

Consider or suspect abuse (particularly malnourishment) as a contributory factor to or cause of pressure ulcers in children. Abuse may also coexist with pressure ulcers. See the NICE guideline on child maltreatment for clinical features that may be associated with maltreatment.

This section has been agreed with the Royal College of Paediatrics and Child Health.

Safeguarding adults

The Department of Health and Social Care has issued a protocol for safeguarding adults at risk of pressure ulcers. It aims to help practitioners and managers across health and care organisations to provide caring and quick responses to people at risk of developing pressure ulcers.

It includes a process for deciding whether an adult safeguarding response is needed.