Pressure ulcers

Pressure ulcers/injuries are areas of localised damage to the skin and/or underlying tissue, usually over bony prominences or related to a medical or other devices, resulting from prolonged pressure or pressure in combination with shear (EPUAP, 2019).

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 in people who are seriously ill, have a neurological condition, impaired mobility, impaired nutrition, poor posture or a deformity (NICE, 2014).

The National Wound Care Strategy Programme (NWCSP) was commissioned by NHS England to improve the prevention and care of pressure ulcers, leg and foot ulcers and surgical wounds. Below are their recommendations.

NWCSP-PU-Clinical-Recommendations-and-pathway-final-24.10.23

Prevention and management

Pressure ulcers present a major health care challenge.   It has been recognized that pressure ulcers place a huge financial burden on the health care system and additionally result in a poor quality of life for the patient with an increased risk of morbidity.  It is also known that many pressure ulcers are avoidable.

Efforts to reduce occurrence of pressure ulcers need to focus on prevention rather than cure.  If we are to manage rates of pressure ulceration best practice needs to be employed by the use of guidelines, educational support and provision of appropriate equipment.

Braden tool

Nice guidance (2104) recommends using a validated scale to support clinical judgement when assessing pressure ulcer risk. Oxford Health has adopted the Braden tool as its pressure ulcer risk tool as it proven to provide higher inter-rater reliability and consistency of patient risk assessment.

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) should be undertaken on admission, or on the 1st visit in the community setting (NICE, 2014)

Resources

The following documents are available to clinicians to assist in pressure ulcer prevention and management:

Other documents found elsewhere on this site that may be useful include:

  • Oxford Health Pressure Area Care Leaflet
  • Oxfordshire Community Pressure Relieving Equipment Leaflet
  • Role of dietary factors in TV and wound Healing
  • A variety of food fortification leaflets
  • Skin Inspection – Guidance & Form

Page last reviewed: 29 April, 2025