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CH123-Pressure Ulcer Prevention and Management Policy

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Pressure Ulcer Prevention and Management Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} takes a proactive, evidence-based approach to preventing and managing pressure ulcers. Pressure ulcers (also known as pressure sores or bedsores) can cause serious harm, pain, and infection, and their prevention is a key indicator of high-quality care.

This policy ensures:

2. Scope

This policy applies to:

3. Legal and Regulatory Compliance

This policy must be implemented in accordance with applicable legislation, regulatory requirements and nationally recognised clinical guidance. The registered provider and registered manager remain responsible for ensuring that pressure-ulcer prevention and management arrangements are safe, person-centred, properly documented and reviewed.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The following regulations are directly relevant to the prevention and management of pressure ulcers:

Care Quality Commission (Registration) Regulations 2009

The registered person must make statutory notifications to the Care Quality Commission where the circumstances meet the requirements of the Care Quality Commission (Registration) Regulations 2009. This includes relevant serious injuries, abuse or allegations of abuse, incidents involving the police and other events specified by the Regulations. Pressure-ulcer category alone must not be used as a substitute for assessing the statutory notification criteria.

Care Act 2014

Where there is reasonable cause to suspect that a person with care and support needs is experiencing, or is at risk of, abuse or neglect and is unable to protect themselves because of those needs, staff must raise the concern in accordance with local safeguarding procedures and the service’s Safeguarding Adults Policy.

Mental Capacity Act 2005

Staff must presume capacity unless established otherwise. Where a person cannot make a specific decision regarding pressure-ulcer prevention, repositioning, wound treatment or photography because they lack capacity, any decision must be made in accordance with the Mental Capacity Act 2005, including the best-interests principles and the requirement to use the least restrictive option.

National Guidance

Practice under this policy must take account of current applicable national guidance, including:

Where national or local clinical guidance is updated, the most current applicable version must be followed and this policy reviewed accordingly.

4. Pressure Ulcer Prevention Strategies

4.1 Risk Assessment for Pressure Ulcers

All people using the service must be considered potentially at risk of developing pressure damage. Pressure-ulcer risk must be assessed on admission and thereafter in accordance with the person’s individual clinical needs and the service’s assessment process.

A validated pressure-ulcer risk assessment tool, such as Waterlow, Braden or another locally approved validated tool, may be used to support clinical judgement. A numerical score must not be used in isolation and must not replace professional or clinical judgement.

The assessment must consider, where relevant:

A person with a current pressure ulcer or a history of pressure ulcers must be regarded as being at high risk unless a suitably qualified healthcare professional determines otherwise following assessment.

Pressure-ulcer risk must be reassessed whenever there is a relevant change in the person’s clinical condition or circumstances, including deterioration in health, reduced mobility, acute illness, hospital admission or discharge, surgery, significant change in nutritional status or development of new skin damage.

People assessed as being at high risk must receive a skin assessment by a staff member or healthcare professional who has been trained and assessed as competent to undertake the assessment within their role.

Skin assessment must include relevant pressure areas and consider:

Staff must recognise that non-blanching erythema may present differently on darker skin tones and must not rely solely on visible redness when assessing pressure damage.

Where non-blanching erythema or other suspected pressure damage is identified, preventative action must be initiated promptly, the finding must be documented and the person’s risk assessment and care plan must be reviewed. Appropriate clinical advice must be obtained where required.

4.2 Preventative Measures

Pressure-ulcer prevention must be based on each person’s individual risk assessment, skin assessment, mobility, clinical condition, preferences and care plan. Preventative measures must be reviewed whenever the person’s needs or risks change.

Repositioning and mobility

People who are able to reposition themselves must be encouraged and supported to change position regularly.

For adults assessed as being at risk of developing a pressure ulcer, repositioning must occur frequently and at least every six hours unless the person’s individual assessment and care plan require a different or more frequent schedule.

For adults assessed as being at high risk of developing a pressure ulcer, repositioning must occur frequently and at least every four hours unless their individual assessment and care plan requires more frequent repositioning.

Where a person cannot reposition themselves independently, staff must provide the assistance and appropriate equipment required.

The person’s care plan must clearly state:

All required repositioning must be documented contemporaneously. Where repositioning cannot be completed as planned, the reason, action taken and any escalation must be recorded.

Staff must not massage or rub skin for the purpose of preventing pressure ulcers.

Pressure redistribution and equipment

Adults assessed as being at high risk must have access to an appropriate high-specification foam mattress or other pressure-redistributing surface in accordance with clinical assessment.

For people who sit for prolonged periods or use a wheelchair, seating needs must be assessed and an appropriate pressure-redistributing cushion considered.

Where a person is at high risk of heel pressure damage, an individualised heel-offloading strategy must be agreed and documented.

All pressure-relieving equipment must:

Skin care and moisture management

Skin must be kept clean and appropriately dry while avoiding unnecessary friction or trauma.

Where a person is at high risk of moisture-associated skin damage or incontinence-associated dermatitis, an appropriate barrier preparation must be considered as part of the person’s skin-care plan.

Continence support must be person-centred and must minimise prolonged skin exposure to urine, faeces, perspiration or wound exudate.

Nutrition and hydration

People at risk of pressure ulcers must have their nutritional and hydration needs assessed and supported.

Where malnutrition or nutritional deficiency is suspected, an appropriate nutritional assessment and referral must be arranged.

Nutritional supplements must not be provided specifically to prevent pressure ulcers where the person’s nutritional intake is already adequate unless advised for another clinical indication by an appropriately qualified healthcare professional.

Hydration must be supported according to the person’s assessed needs, care plan and any clinical restrictions.

4.3 Staff Training in Pressure Ulcer Prevention

Staff involved in pressure-ulcer prevention or management must receive training, supervision and competency assessment appropriate to their responsibilities.

Training must include, as applicable to the member of staff’s role:

Staff undertaking skin or wound assessment, wound treatment or dressing changes must only do so where this is within their role and they have received appropriate training and have been assessed as competent.

Competence must be reviewed where concerns arise, following relevant incidents or changes in practice, and at intervals determined by the provider’s training and competency arrangements. Attendance at training alone must not be treated as evidence of competence.

5. Managing Pressure Ulcers

5.1 Identifying and Documenting Pressure Ulcers

Where pressure damage or a pressure ulcer is identified or suspected, staff must take prompt action to protect the person from further harm and ensure appropriate assessment.

The pressure ulcer must be assessed and categorised using a recognised and validated pressure-ulcer classification system by a person who is appropriately trained and competent to undertake that assessment.

The record must include, where applicable:

The pressure ulcer must be re-assessed and its classification documented whenever it is reviewed in accordance with the wound-care plan or sooner if deterioration occurs.

Where a photograph is clinically appropriate for assessment or monitoring, the person’s valid consent must be obtained and recorded. Where the person lacks capacity to consent to photography, staff must act in accordance with the Mental Capacity Act 2005 and document the lawful basis and best-interests decision before photography takes place. Photographs must be stored securely as part of the person’s care record and processed in accordance with the service’s information-governance requirements.

The senior member of staff responsible for the person’s care must be informed promptly of any new pressure ulcer or significant deterioration.

An incident report must be completed for pressure damage arising during the service where required under the provider’s incident-reporting arrangements. Completion of an internal incident report does not replace any separate requirement to make a safeguarding referral, CQC statutory notification, Duty of Candour notification or referral to a healthcare professional.

5.2 Wound Care and Treatment Plans

Every person with a pressure ulcer must have an individualised wound-care and pressure-ulcer management plan based on appropriate clinical assessment.

Treatment must be undertaken by, or in accordance with instructions from, a healthcare professional who is appropriately qualified and competent to assess and manage the wound.

The care plan must address, where relevant:

Adults with a pressure ulcer must receive an appropriate nutritional assessment by a dietitian or another healthcare professional with the necessary skills and competence where this has not already been completed.

Adults with a nutritional deficiency must be offered appropriate nutritional support or supplementation in accordance with clinical advice. Nutritional supplements must not be used specifically to treat a pressure ulcer where nutritional intake is adequate unless there is another clinical indication.

Adults with a pressure ulcer must normally be provided with an appropriate high-specification foam mattress. Where this does not provide adequate pressure redistribution, a dynamic support surface must be considered following clinical assessment.

Dressings must be selected according to the person’s individual needs and wound assessment, taking account of:

Gauze dressings must not be routinely used to treat pressure ulcers.

Topical antiseptics or antimicrobials must not be routinely used to treat an adult pressure ulcer. They may only be used where clinically indicated and in accordance with an appropriate healthcare professional’s treatment plan.

Systemic antibiotics must not be used specifically to promote pressure-ulcer healing or solely because a wound culture is positive in the absence of clinical evidence of infection.

All treatment provided, changes in the wound and advice received from healthcare professionals must be documented contemporaneously.

5.3 Escalation and External Referrals

Any new pressure ulcer, significant deterioration in existing pressure damage or concern regarding wound healing must be assessed promptly and escalated in accordance with the person’s needs and the applicable local NHS wound-care or tissue-viability pathway.

Staff must not wait for a pressure ulcer to reach Category 3 or Category 4 before obtaining healthcare-professional advice where earlier assessment or treatment is clinically indicated.

Referral may include the person’s GP, community or district nursing service, tissue viability or specialist wound-care service, dietitian or another relevant healthcare professional according to the person’s needs and local arrangements.

Urgent medical assessment must be sought where there are signs of significant infection, acute deterioration or other clinical concern.

In particular, staff must urgently escalate suspected:

Emergency services must be contacted where the person’s condition indicates a medical emergency.

All referrals and escalations must be recorded, including:

Staff must continue to provide and document pressure-relieving care, skin monitoring and other interventions specified in the person’s care plan while awaiting clinical review unless advised otherwise by an appropriate healthcare professional.

Where another healthcare provider is responsible for wound treatment, the care home remains responsible for implementing the aspects of the agreed care plan that fall within its role, monitoring the person’s condition and escalating any deterioration or failure to receive required healthcare input.

6. Infection Prevention and Control in Pressure Ulcer Care

Pressure-ulcer and wound care must be undertaken in accordance with the service’s Infection Prevention and Control Policy, applicable national guidance and any instructions provided by the healthcare professional responsible for the person’s wound-care plan.

Staff must:

Staff must obtain urgent medical advice where sepsis is suspected.

Systemic antibiotics must only be used in accordance with appropriate prescribing and clinical advice. For adults with pressure ulcers, clinical indications for systemic antibiotic treatment include systemic sepsis, spreading cellulitis or underlying osteomyelitis.

A positive wound culture alone, without clinical evidence of infection, must not be treated as sufficient reason to commence systemic antibiotics.

Topical antiseptics and antimicrobials must not be routinely used for adult pressure ulcers and may only be used where clinically indicated as part of an appropriate treatment plan.

7. Monitoring and Compliance

7.1. Quality Assurance and Audit

7.2 Incident Reporting, Safeguarding and CQC Notifications

All new pressure ulcers and significant deterioration in existing pressure damage must be considered under the service’s incident-reporting arrangements so that the circumstances, contributing factors and required actions can be identified.

The category of a pressure ulcer must not, by itself, be treated as a definitive measure of the actual harm experienced by the person. Harm must be assessed according to the effect of the incident on the individual.

CQC statutory notifications

The registered provider or registered manager must notify the Care Quality Commission without delay where an incident meets a statutory notification requirement under the Care Quality Commission (Registration) Regulations 2009.

For pressure-ulcer incidents, the registered person must consider whether the circumstances constitute a serious injury within Regulation 18, including where, in the reasonable opinion of a healthcare professional, the injury:

The registered person must also make any other notification required by Regulation 18, including where applicable abuse or an allegation of abuse, or an incident that has been reported to or investigated by the police.

Staff must immediately inform the registered manager, or the person designated to act in their absence, of any incident that may require a statutory CQC notification.

A decision not to notify CQC where notification has been considered must be supported by an appropriate rationale and recorded.

Safeguarding

The development of a pressure ulcer does not automatically establish abuse or neglect. However, staff must consider whether the circumstances indicate suspected or actual abuse, neglect, acts of omission, organisational abuse or avoidable harm.

A safeguarding concern must be raised with the local authority in accordance with the Care Act 2014, local safeguarding procedures and the service’s Safeguarding Adults Policy where the applicable safeguarding threshold is met.

A safeguarding referral does not replace a statutory CQC notification, and a CQC notification does not replace a safeguarding referral. Both requirements must be considered separately.

Incident review and learning

Pressure-ulcer incidents must be reviewed proportionately according to the level of harm, risk, recurrence and concerns identified.

The review must establish, where relevant:

Actions and learning arising from reviews must be recorded, implemented and monitored through the service’s governance arrangements.

7.3 Duty of Candour

The registered provider and registered manager must act in an open and transparent way with people receiving care and treatment.

Where a pressure-ulcer incident meets the statutory definition of a notifiable safety incident under Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the registered person must comply with the statutory Duty of Candour.

The relevant person, or their lawful representative where appropriate, must be informed as soon as reasonably practicable after the registered person becomes aware that a notifiable safety incident has occurred.

The notification must:

The verbal notification must be followed by written notification containing the information provided, details of any further enquiries and an apology.

The service must keep a secure written record of:

Duty of Candour must be considered separately from internal incident reporting, safeguarding referrals and CQC statutory notifications. Completion of one process does not remove the obligation to consider the others.

Where an incident does not meet the statutory threshold for a notifiable safety incident, the general requirement to act openly and transparently with the person remains applicable.

8. Related Policies

This policy should be read alongside:

9. Policy Review

This policy will be reviewed annually or earlier if regulatory updates or incidents require changes

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