Guidance

Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Adults: risk assessment

  • Carry out and document an assessment of pressure ulcer risk for adults:

    • being admitted to secondary care or care homes in which NHS care is provided or

    • receiving NHS care in other settings (such as primary and community care and emergency departments) if they have a risk factor, for example:

      • significantly limited mobility (for example, people with a spinal cord injury)

      • significant loss of sensation

      • a previous or current pressure ulcer

      • nutritional deficiency

      • the inability to reposition themselves

      • significant cognitive impairment.

Adults: skin assessment

  • Offer adults who have been assessed as being at high risk of developing a pressure ulcer a skin assessment by a trained healthcare professional (see recommendation 1.3.4). The assessment should take into account any pain or discomfort reported by the patient and the skin should be checked for:

    • skin integrity in areas of pressure

    • colour changes or discoloration

      Healthcare professionals should be aware that non-blanchable erythema may present as colour changes or discolouration, particularly in darker skin tones or types.

    • variations in heat, firmness and moisture (for example, because of incontinence, oedema, dry or inflamed skin).

All ages: care planning

  • Develop and document an individualised care plan for neonates, infants, children, young people and adults who have been assessed as being at high risk of developing a pressure ulcer, taking into account:

    • the outcome of risk and skin assessment

    • the need for additional pressure relief at specific at-risk sites

    • their mobility and ability to reposition themselves

    • other comorbidities

    • patient preference.

Adults: repositioning

  • Encourage adults who have been assessed as being at risk of developing a pressure ulcer to change their position frequently and at least every 6 hours. If they are unable to reposition themselves, offer help to do so, using appropriate equipment if needed. Document the frequency of repositioning required.

Adults: devices for prevention of pressure ulcers

  • Use a high-specification foam mattress for adults who are:

    • admitted to secondary care

    • assessed as being at high risk of developing a pressure ulcer in primary and community care settings.

Neonates, infants, children and young people: risk assessment

  • Carry out and document an assessment of pressure ulcer risk for neonates, infants, children and young people:

    • being admitted to secondary care or tertiary care or

    • receiving NHS care in other settings (such as primary and community care and emergency departments) if they have a risk factor, for example:

      • significantly limited mobility (for example, people with a spinal cord injury)

      • significant loss of sensation

      • a previous or current pressure ulcer

      • nutritional deficiency

      • the inability to reposition themselves

      • significant cognitive impairment.

All ages: healthcare professional training and education

  • Provide training to healthcare professionals on preventing a pressure ulcer, including:

    • who is most likely to be at risk of developing a pressure ulcer

    • how to identify pressure damage

    • what steps to take to prevent new or further pressure damage

    • who to contact for further information and for further action.

  • Provide further training to healthcare professionals who have contact with anyone who has been assessed as being at high risk of developing a pressure ulcer. Training should include:

    • how to carry out a risk and skin assessment

    • how to reposition

    • information on pressure redistributing devices

    • discussion of pressure ulcer prevention with patients and their carers

    • details of sources of advice and support.

Adults: management of heel pressure ulcers

  • Discuss with adults with a heel pressure ulcer and if appropriate, their carers, a strategy to offload heel pressure as part of their individualised care plan. (See also the NICE guideline on diabetic foot problems for advice on heel pressure offloading.)