Display Patient Information Leafelts

Pressure Ulcer Prevention

Date issued:  June 2020

For review: June 2022

Ref: C-400/PP/tissue viability/Pressure ulcer prevention

PDF: Pressure Ulcer Prevention [pdf] 517KB

What are pressure ulcers?

Pressure ulcers are areas of damage to the skin and the tissues below as a result of being placed under pressure. They usually occur over a bony prominence although they can also occur under or around medical devices. They are also known as pressure sores or bedsores.

Pressure ulcers may cause pain or lead to an extended hospital stay. They can become infected; leading to blood poisoning or bone infection and in extreme case can become life-threatening.

What causes pressure ulcers?

Pressure ulcers are caused by a combination of:

Pressure: from body weight pressing against a hard surface, damaging the blood supply to that area.

Shearing: this may occur if you slide down, or are dragged up the bed or chair and may damage the deeper layers of skin.

Common body sites for pressure ulcers: usually over bony prominences.

Examples of Common Locations

  • Ears, Back of Head
  • Elbows
  • Knees
  • Hip, Bottom
  • Ankle
  • Heels

Pressure Ulcers can also occur under medical devices such as oxygen masks or tubing or under anti-embolism stockings so it is important for you to inform your nurse if anything is causing you discomfort or pain.

Are you at risk of pressure ulcers?

Assess the Risk

  • There are things we need to know to help to prevent a pressure ulcer developing:
  • Tell us if you’re not eating as much as you used to.
  • Tell us if you’re not moving as much as you used to.
  • Tell us if you have a sore bottom, heels, elbows, hips or any other area of skin.
  • Tell us if any of the equipment / tubes / masks are rubbing or causing pain.
  • Tell us if you think there are any problems with your mattress / cushion.
  • Tell us if you have any continence problems.
  • Tell us if you have reduced sensation in your feet.
  • Tell us if you have had a pressure ulcer before.

ALL of these can increase your risk of pressure ulcers.

We will examine you and carry out a risk assessment; in discussion with you we will then agree a prevention plan to reduce your risks and which should include:

  • Regular Skin Assessment.
  • Regular repositioning.
  • Use of specialist equipment if needed (e.g. mattress, cushions).
  • Assistance to “float” your heels clear of the bed.
  • Referral to other healthcare professionals if required e.g. Physiotherapist, Occupational Therapist, Tissue Viability, Dietitian.
  • Reassessment if anything changes.

What can you and your family / carer do to help prevent pressure ulcers

Skin Inspection

If you are able, please inspect your skin daily and report the following changes to the nurse looking after you:

  • Redness on lighter skin that doesn’t go white when light finger pressure is applied.
    • On darker skin this can be more difficult to see so look for areas that are a different skin tone or areas that feel warm or harder.
  • Blisters / Swelling / abrasions
  • Purple / black discolouration to the skin (may look like a bruise on bony areas).

Surface

  • A pressure relieving mattress or cushion may be provided that will help to reduce the amount of pressure on your body.
  • Whilst you are in bed we will ask you to “float” your heels using pillows and the position of the bed so that they don’t rest on the bed and damage. If this causes a problem please ask your nurse for advice as other types of equipment may be available.
  • This equipment can help to reduce your risk but you will still need to keep moving or be helped to reposition.
  • Please tell your nurse if the equipment provided is uncomfortable or not working.

Keep Moving

  • Keeping moving is the best way to help prevent pressure ulcers.
  • If you are able to, change your position frequently; please ask staff to assist you if you need help. Staff should always use a slidesheet to assist in repositioning you in order to reduce any friction.
  • Do not dig your heels into the mattress when pushing yourself up the bed. Bend your knees and place your feet flat on the mattress to avoid extra pressure on the heels. Please ask your nurse for help if you find your feet slip when moving.
  • If you are able to sit out of bed please continue to change your position. Check with your nurse who will advise if you are able to “sit and stand”, “march on the spot” or go for a short walk around your bed. Nursing staff will provide assistance to move if they feel you should not yet be doing this alone.
  • Make sure shoes and slippers fit well and that socks and hospital stockings are removed daily for skin care and skin checks.

Incontinence

Wet skin can increase the risk of pressure ulcers, avoid soap if you are having to wash frequently and ask your nurse for advice about the types of cleanser to use. Pat skin dry gently and use barrier products as advised.

Please discuss with staff the possible cause of your incontinence and any actions that may help prevent this e.g. regular visits to the toilet.

Be aware that barrier products will not prevent pressure ulcers and keeping moving is still important.

Nutrition

Adequate nutrition and fluids are essential to keep your skin healthy and strong. Nurses may monitor your food and fluid intake and may suggest supplements if needed. Please ask for advice if you are concerned.

Giving / Sharing Information

Staff will discuss with you if you are at risk of pressure ulcers and will offer advice on how to prevent them. Please let us know if you are already receiving support at home for pressure ulcers as this can help us to plan your discharge    (e.g. District nurse visits, special equipment or dressings).

 

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