Bed sores, pressure sores and pressure ulcers information for patients and carers
The following information is to provide you and your carer with information on pressure ulcers, how they develop and the steps you can take to prevent them. Occasionally there may be good reasons why your treatment is different to this advice and you should discuss this with your healthcare professional.
What is a pressure ulcer?
A pressure ulcer is damage that occurs on the skin and underlying tissues due to the lack of blood and oxygen supply. This may happen due to:
Pressure:
- The weight of the body pressing down on the skin.
- Any object or device for example catheter tubing pressing on the skin.
Shearing:
This can occur if the patient slides down in the bedor chair. The skin becomes stretched and tears.
The first sign that a pressure ulcer may be forming is usually pain and discoloured skin. This may get progressively worse and eventually lead to an open wound. The most common places for pressure ulcers to occur are over bony parts of the body like the bottom, heel, hip, elbow, ankle, shoulder, back and the back of the head.
Who is at risk?
Anyone can get a pressure ulcer but some people are more likely to develop them than others. They can develop quickly in people if they are unable to move for a very short time. They can be serious, not just damaging the skin but deep layers of tissue; in severe cases, muscle and bone and can take a long time to heal.
For example, they can develop in people who:
- have problems moving and cannot change position by themselves without help.
- cannot feel pain over part or all of their body.
- have problems with bowel or bladder control (incontinence).
- currently have a pressure ulcer.
- have had pressure ulcers in the past.
- have an injury that affects movement.
- are unwell.
- have to wear a splint or body brace.
- have problems with memory and understanding, such as dementia.
Remember - SSKIN
(Surface, Skin inspection, Keep moving, Incontinence, Nutrition and hydration)
Surface
Pressure relieving equipment, such as a mattress or chair cushion, may be necessary to help reduce the amount of pressure on your body.
Pressure ulcers can also occur under medical devices used to treat your condition. For example an oxygen mask, tubing, catheter, cast or neck collar. It is important that you inform a healthcare professional if you have a poorly fitting or painful medical device or if any of the equipment you have been provided with is not working or is uncomfortable.
Areas of the body where pressure ulcers are most likely to occur are:
- Sitting in bed
- Sitting in a chair or wheelchair
- Lying down
Skin inspection
You should check your skin every day when washing and dressing to check for warning signs of damage. You can use a mirror or ask a carer to check any awkward areas.
What are the warning signs?
- red patches on fair skin.
- purple / black patches on dark ski.
- swelling and blisters.
- hard or swollen areas which may be painful.
Noticing symptoms early is important so steps can be taken to prevent a pressure ulcer developing.
Keep moving
Regular movement is key to prevention, whether you’re in bed or sat out in a chair.
Simple movements such as lifting your heels, tilting to the side and lifting your bottom off the chair or bed will reduce the pressure on these areas.
Good sitting posture helps reduce pressure on bony areas. Lift the bottom regularly if you are safe to do so to relieve pressure.
If you have pressure damage to your skin, sitting or lying on the area should be avoided as it will delay healing and make the ulcer worse.
Incontinence
Damp skin may be damaged more easily by pressure, for example, urine, faeces or sweat. Keep the skin clean and dry and regularly moisturise. Incontinence must be managed properly, a healthcare professional can help you with this.
Nutrition and hydration
Eat a good diet, plenty of fresh fruit, vegetables and protein rich foods (e.g. meat, fish, eggs, cheese, and dairy products). If you have enteral feeding, ensure you have all the feed and water as prescribed. Report any unintentional weight loss to a healthcare professional as this can increase your pressure ulcer risk - you may be referred to a dietitian.
Drink adequate fluids to keep your skin soft and supple.
Practical hints and tips
Your healthcare professional should advise you and your carer on how pressure is best reduced or relieved on areas of skin that are vulnerable to pressure ulcers.
Do…
- Change your position frequently, while in bed or sitting in a chair, avoid being in one position for long periods of time. take good care of your skin, keep it clean.
- Try to eat a healthy balanced diet.
- Use the equipment as advised by your healthcare professional.
- Inspect your skin for changes in colour, such as red marks or purple/black discolouration.
Don’t…
- Try to manage a pressure ulcer yourself – seek help from your healthcare professional.
- Sit on rubber ring cushions (may cause more damage) massage or rub pressure areas.
- Drag yourself over damp or creased bed clothes.
- Use a sheepskin to help relieve pressure – this is merely a comfort measure.
- Allow incontinence sheets to crease up under you – avoid their use if you can.
If you already have a pressure ulcer, lying or sitting on the ulcer should be avoided as this will make the ulcer worse.
Remember…
It’s important to look after your skin by:
- Moving regularly.
- Eating and drinking well.
- Telling a healthcare professional if you have any pain or discomfort.
If you would like any more information or have any concerns, please speak to a healthcare professional who can refer you to the appropriate service - Neighbourhood Team, Tissue Viability Service, Physiotherapist, Dietitian, Occupational Therapist and Back Care Advisors.
