26 | Nursing in Practice | Winter 2022
CLINICAL
Prevention and management
of pressure ulcers
The latest clinical guidance in general practice and community nursing nursingin practicelearning . co . uk
1.5 CPD HOURS
Key points
• Most pressure ulcers are preventable but , despite extensive programmes of work to reduce their occurrence , their treatment accounts for more than two-thirds of NHS spend on wound care
• Nutrition and hydration are vitally important to maintaining skin elasticity to help prevent pressure ulcers
• The risk of pressure ulcer development should be assessed using a validated tool alongside clinical judgement
• Skin assessment involves more than what the eye can see . Changes in skin colour , temperature , texture , visible swelling and reports of pain are all potential indicators of underlying pressure damage
• Support surfaces , such as mattresses and cushions , should be chosen based on individual need , and at-risk patients should be encouraged to change position at least every six hours , or four hourly for those at high risk
A pressure ulcer can be defined as : ‘ Localised damage to the skin and / or underlying tissue , usually over a bony prominence ( or related to a medical or other device ), resulting from sustained pressure ( including pressure associated with shear ). The damage can be present as intact skin or an open ulcer and may be painful .’ 1
Pressure ulcers range in depth and severity , as defined by the National and European Pressure Ulcer Advisory Panel categorisation system ( see Box 1 ). 2
All people , regardless of their age , are potentially at risk of developing pressure ulcers . However , there are certain risk factors that make people more susceptible , or increase the risk of existing pressure ulcers deteriorating . These include : 4 , 5
• Acute illness .
• Impaired or reduced mobility .
• Medical conditions that reduce blood supply or increase fragility of the skin ( for example , diabetes , peripheral arterial disease , heart failure , multiple sclerosis , kidney disease and Parkinson ’ s disease ).
• Incontinence or skin moisture .
• Compromised nutrition and hydration .
• Cognitive impairment .
• Poor posture or a deformity .
• Palliative care needs .
Pressure ulcer prevention and management strategies are therefore required across a variety of health and social care settings . These include acute care , community services , primary care , hospices , care homes and home care services . 4 , 5
Box 1 Pressure ulcer categorisation 2
• Blanching erythema
• Category 1 : non-blanchable erythema
• Category 2 : Partial thickness skin loss
• Category 3 : Full thickness skin loss
• Category 4 : Full thickness tissue loss
• Suspected deep tissue injury : depth unknown
• Device-related pressure ulcers ( DRPU )
Further information , including images showing examples of pressure ulcers , is available from NHS Improvement . 3
ALAMY