Information for patients This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request. This leaflet has been adapted from a NICE guideline; April 2014 1 and a NICE quality standard June 2015 2.. It tells you about pressure ulcers and how to prevent them. What are pressure ulcers? Pressure ulcers are areas of damaged skin and flesh. They are also known as bed sores or pressure sores. They are caused by 2 main things: pressure. The weight of the body pressing down on the skin. shear. The layers of skin are forced to slide over one another, for example, when you slide down, or are moved up the bed or when you are being transferred, such as from a bed to a chair. Tight clothing or anything that stops you moving easily can also cause problems. Pressure ulcers can develop in only a few hours. They usually start with changes to the skin; it may appear red or darker in colour, or feel hot or cold. The redness will not blanch (turn white) when lightly pressed. You may feel pain, tenderness or tingling. If the cause of the problem is not removed as early as possible then the skin can blister and a deep ulcer can develop. If you do have any of these symptoms then you must tell your nurse or GP, or ask a relative, friend or carer to contact your nurse or GP for you. He or she will give you advice on what to do next. Please talk to your nurse if you would like to know more about pressure ulcers. Where do pressure ulcers occur? You can get a pressure ulcer anywhere on your body. The most common places are those parts of your body which take your weight when you are lying or sitting and where your bone is close to the surface, for example, your buttocks (bottom), sacrum (base of spine), heels, hips, elbows, ankles, shoulders, spine (back) or back of your head. (See diagrams overleaf.) Corp/236.3 (2016) Page 1 of 6 For Review Summer 2019
Am I at risk of getting a pressure ulcer? Between 4-10 patients in every 100 develop a pressure ulcer in hospital 1, however it is unknown how many patients in a community and care home setting will develop a pressure ulcer 1. Your body usually protects you from ulcers by telling you to move. If you are unwell or have lost feeling in parts of your body you may not be able to move and will be at risk. You are more likely to develop pressure ulcers if you: have to stay in bed are in a wheelchair cannot move around very well have a serious illness are elderly or weak are incontinent (poor bladder or bowel control) have poor circulation have poor feeling in your skin are not eating and drinking enough are using medication which affects the skin, for example, steroids. Corp/236.3 (2016) Page 2 of 6 For Review Summer 2019
Whether you are in hospital or in your own home you will hear the following terms used as part of your care: Braden assessment this is your risk score of developing a pressure damage. MUST assessment this is an assessment tool to check your nutritional status. SSKIN bundle this is a tool used to check all 5 key areas of pressure prevention are being met. How can I avoid pressure ulcers? You can help reduce the risk of developing a pressure ulcer by moving on a regular basis to ease the pressure on your skin and by eating a healthy balanced diet. Your skin provides a barrier to protect you from many things including harmful substances, bacteria and infection. It is important that your skin is well cared for. If you are unable to check your own skin, a carer, nurse or relative can do so with your consent. You should also: change your position on a regular basis if you are in bed. If you are unable to do this yourself your nurse will help you or offer advice and support to your relatives and carers on how best to help you. Your nurse may also give you a special mattress or cushion to help ease the pressure on your skin. try to avoid crumbs and creases in your bed. try not to slouch when you sit up, as this position drags your skin and can cause damage. take the weight off your bottom if you are sitting in your chair by standing up or rolling from side to side, at least every hour. If you are at risk then the amount of time you spend sitting in a chair may be limited by having periods of bed rest through the day. This is because your weight is more spread out in bed than in a chair. not cross your legs. You must tell your nurse, relative or carer if you feel soreness, numbness, tingling or if your skin becomes discoloured (redness or darker areas). What else can I do to help? You should try to: eat a healthy balanced diet and drink plenty of fluids (not alcohol). Corp/236.3 (2016) Page 3 of 6 For Review Summer 2019
keep your skin clean and well moisturised. avoid using highly perfumed soap and shower gel as they can irritate your skin. allow staff, relatives or carers to help you if you have difficulty changing your position. remember, it is important to seek advice early from your nurse, GP, relative or carer if you notice any skin changes or tenderness of your skin. What can I expect to happen if I am in hospital? A nurse will assess (check) your risk of developing a pressure ulcer and may ask to inspect your skin regularly throughout your stay in hospital. How often this is done will depend on how active and well you are. Everyone is different. If you are considered at risk of developing a pressure ulcer, a plan of care will be agreed with you. All the standard mattresses used on hospital beds are made from special foam that helps reduce the risk of developing a pressure ulcer; however, for some patients a special mattress and/or cushion may be provided. Pressure ulcers can sometimes develop even if everything is being done to prevent them, especially if you are very ill. If you develop, or have, a pressure ulcer you may need treatment to help it heal. Treatment may include dressings, removing damaged skin and other methods of helping your pressure ulcer to heal. A nurse will work with you to decide the best treatment for your pressure ulcer, including the use of pressure relieving equipment. What can I expect to happen if I am in my own home or a care home? A nurse or carer will assess your risk of developing a pressure ulcer and may ask to inspect your skin regularly. How often this is done will depend on how active and well you are. Everyone is different. If you are considered at risk of developing a pressure ulcer, a plan of care will be agreed with you. You may be provided with a special mattress and/or cushion which will help to reduce the risk of you developing a pressure ulcer. Pressure ulcers can sometimes develop even if everything is being done to prevent them, especially if you are very ill. If you develop, or have, a pressure ulcer you may need treatment to help it heal. If you live in a care home you may be referred to your GP or a community nurse for this treatment. Treatment may include dressings, removing damaged skin and other methods of helping your pressure ulcer to heal. A nurse will work with you to decide Corp/236.3 (2016) Page 4 of 6 For Review Summer 2019
the best treatment for your pressure ulcer, including the use of pressure relieving equipment. What will happen to any photographs that are taken of my pressure ulcer? As part of your treatment some kind of photographic record may be made, for example, clinical photographs. You will always be told if this is going to happen. The photograph will be kept as part of your healthcare record. This means it will be seen only by those involved in providing you with care or those who need to check the quality of care you have received. The use of photographs is very important in teaching and medical research. However, we will not use these in a way which would allow you to be identified or recognised, without your permission. If you do not want your photographs to be used for teaching purposes please tell your doctor or nurse. If a doctor or nurse wishes to use these outside North Tees and Hartlepool NHS Foundation Trust, or for publication, you will be asked to give written consent. A full explanation will be given before you are asked to sign the consent form. Further information is available from: NHS Choices telephone: 111 (when it is less urgent than 999) Calls to this number are free from landlines and mobile phones or via the website at www.nhs.uk The Your Turn Campaign at www.your-turn.org.uk Stop the Pressure Campaign at www.nhs.stopthepressure.co.uk References 1. National Institute for Health and Clinical Excellence (NICE) Guideline Pressure Ulcers: Prevention and Management April 2014 2. National Institute for Health and Clinical Excellence (NICE) Quality Standard Pressure Ulcers June 2015 Corp/236.3 (2016) Page 5 of 6 For Review Summer 2019
This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Quality Assurance Team, University Hospital of North Tees or email: patientinformation@nth.nhs.uk. Comments, Concerns, Compliments or Complaints We are continually trying to improve the services we provide. We want to know what we re doing well or if there s anything which we can improve, that s why the Patient Experience Team is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. If you would like to contact or request a copy of our PET leaflet, please contact: telephone: 01642 624719 Monday Friday, 9.00 am 4.00 pm Messages can be left on the answering machine and will be picked up throughout the day. freephone: 0800 092 0084 Mobile: (can use text): 0779 506 1883 Email: patientexperience@nth.nhs.uk Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person. telephone: 01642 617617 24 hours a day, 7 days a week The Patient Experience Team is available to discuss your concerns in person Monday Friday, 1.30 pm 4.30 pm. The office is based at the University Hospital of North Tees. It is near the lifts in the main tower block. Data Protection and use of patient information The Trust has developed a Data Protection Policy in accordance with the Data Protection Act 1988 and the Freedom of Information Act 2000. All of our staff respect this policy and confidentiality is adhered to at all times. If you require further information please contact the Information Governance Team. telephone: 01642 833551 or email: information.governance@nth.nhs.uk University Hospital of North Tees, Hardwick, Stockton-on-Tees. TS19 8PE University Hospital of Hartlepool, Holdforth Road, Hartlepool. TS24 9AH Telephone: 01642 617617 Fax: 01642 624089 Corp/236.3 (2016) Page 6 of 6 For Review Summer 2019