Preventing pressure ulcers: skin checks and practical care

1. Know who may be at risk

Illness, pain, weakness, paralysis, sedation or breathlessness can make movement difficult. Reduced sensation may hide discomfort; poor circulation, low food intake, incontinence or a previous injury can add risk. Ask a district or tissue-viability nurse to assess the person and agree a realistic care plan.

2. Check skin every day

With consent, check heels, ankles, hips, bottom, spine, elbows and skin beneath equipment. Look for colour change, blisters, swelling or shiny skin; ask about pain or warmth. On darker skin, purple, blue or darker patches may be easier to notice than redness. Use good light and a mirror if needed.

3. Change position safely

Follow the agreed plan for shifting position in bed and chair. Someone who cannot move independently may need help from a trained carer and suitable equipment. Avoid dragging across sheets. Ask for a review if movement causes pain, the person cannot maintain a position, or night-time arrangements are difficult.

4. Ask about pressure-relieving equipment

A nurse or occupational therapist can assess a pressure-relieving mattress, cushion or heel protection. The choice should fit posture, bed or chair, movement and ability to reposition. Equipment does not replace skin checks. Ask who supplies, fits and repairs it; do not improvise with ring-shaped cushions unless advised.

5. Support skin, food and continence

Keep skin clean and dry and ask a nurse about ongoing soreness or barrier care. Support meals and drinks the person enjoys unless a clinician has set restrictions. Ask for help if appetite, weight, swallowing, continence or hydration changes. Reassess after illness, a fall or reduced mobility.

6. Make the repositioning plan workable

NICE recommends documenting how often a person needs to change position and providing help when they cannot reposition themselves. Ask the nurse to turn that advice into a plan for the actual bed, chair and support available at home. Explain if a carer cannot safely help at night or if turning disrupts sleep because of pain. Request a demonstration of the assessed method rather than copying movements seen elsewhere. Agree where position changes will be noted and who will review the plan when movement or comfort changes.

7. Discuss heels and time spent sitting

Pressure prevention needs to consider sitting as well as lying in bed. NICE recommends discussing a heel-pressure strategy with people at high risk and considering seating needs for prolonged sitting. Ask the assessor to look at the chair actually used, the foot position and whether the person can shift their weight. Explain where discomfort develops during ordinary activities. Request clear instructions about any cushion or heel support, including how it is positioned. Bring up difficulties using the equipment rather than quietly abandoning it or improvising an alternative.

8. Avoid rubbing vulnerable skin

Do not massage or rub skin to prevent pressure damage: NICE advises against this. If an area looks different, tell the nurse rather than trying to rub the colour away. Ask how to check difficult-to-see areas respectfully and how to describe changes over the telephone. NHS Inform explains that pressure damage can develop quickly as well as gradually. Make sure a person who notices a new patch can reach a helper, especially between scheduled visits. Ask for assessment when damage is suspected instead of waiting until an open wound appears.

Common questions