3. Why prevention is so important
• Patients safety
• Quality of life
• Cost implications: In UK
• Category 2 – £6,000/ulcer (monthly)
• Category 4 £14,000/ulcer (monthly)
(Source: Department of Health 2010)
• Can indicate poor practice
4. Who is at risk?
Reduced mobility
Vascular damage
Sensory impairment,
reduced consciousness
Over 65 years old
Malnourished/dehydrated
5. What should we be doing?
• ‘Press your mind to be pressure kind’
• Think about the patients in your care consider are
they at risk-
• Initial assessment to be completed within 6 hours
(NICE 2014)
•Reassess weekly or if condition changes
6. SSKIN assessment
• Support surface –
• mattress and cushion
• Consider patients mobility
• ICES mattress and cushion training
• Consider shear
• Skin inspection: Check for areas of discoloration- press to
see if blanching if not blanching remember this is classed
grade 1
• Keep moving – repositioning and mobilisation
• : Regular turns titrate to needs of patient for example if skin
marking turns may need to be increased-
• NICE guidelines recommend high risk patients should be
encouraged to change position at least 4 hourly.
7. SSKIN continued
• Incontinence/moisture
• Ensure continence needs are met- consider
continence assessment. Barrier cream to protect
against moisture lesions.
• Nutrition and hydration:
• Food and fluid charts-
• Supplements
• MUST assessment weekly
8. Skin Assessment
• P = Press reddened skin to check for
blanching
• U = Uncover the skin and remove stockings
and socks
• L = Lift and check heels with a mirror
• S = Search for redness on the sacrum
• E = Evaluate elbows for redness.
(Nursing standard 2013)
9. Things to consider
• Sitting in a chair is a high risk activity for those at risk of
pressure ulcer development
• When considering a cushion remember to ensure a
comfortable seated position with both feet on floor.
• Air mattresses are good tools but do not take away the
need for regular repositioning
• Needs change every day always remember to reassess.
• Think about circulation
• DOCUMENT!
10. References
• NICE. (2014). Pressure ulcer: prevention and
management. Available:
https://www.nice.org.uk/guidance/cg179?unlid=90931
3302201691914490. Last accessed 12/10/2016.
• RCN. (2013). Pressure ulcers, a guide to eliminating all
avoidable grade 2, 3 and 4 pressure ulcers. Available:
http://nhs.stopthepressure.co.uk/docs/Pressure_ulcer
_care_best_practice.pdf. Last accessed 12/10/2016
