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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Pressure Ulcer Prevention and Management Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides a proactive and effective approach to the prevention, early identification, and management of pressure ulcers for individuals receiving domiciliary care. Pressure ulcers, also known as bedsores, can lead to serious complications if not managed properly. They are largely preventable through good skin care, mobility support, and appropriate intervention.

This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, and the Welsh Government statutory guidance for service providers and responsible individuals on meeting service standard regulations for domiciliary support services. It also reflects CIW notification expectations, relevant NICE guidance on pressure ulcers, Public Health Wales-approved skin integrity assessment arrangements, local health board tissue viability guidance, and the All Wales Tissue Viability Nurse Forum guidance where applicable.

We are committed to:

• Preventing the development of pressure ulcers through early risk assessments and appropriate interventions.
• Providing prompt and effective care when pressure ulcers are identified.
• Training staff to recognise risk factors, implement preventative measures, and provide appropriate wound care.
• Collaborating with healthcare professionals to ensure service users receive the highest standard of care.
• Ensuring pressure ulcer prevention and management is included within the individual’s provider assessment, personal plan, risk assessments and daily care records where this is relevant to the person’s needs, wishes, personal outcomes, mobility, continence, nutrition, hydration, skin integrity and equipment needs.

2. Scope

This policy applies to all staff employed or engaged by {{org_field_name}}, including care workers, senior care workers, team leaders, coordinators, the registered manager, the responsible individual and any agency staff or volunteers involved in the delivery or oversight of domiciliary support. It must also be followed when working in partnership with district nurses, GPs, tissue viability nurses, occupational therapists, physiotherapists, dietitians, speech and language therapists, commissioners and other relevant professionals.

This policy does not authorise care staff to undertake clinical assessment, diagnosis, grading, debridement, prescribing, wound dressing selection or any other clinical task unless this is within their role, they have been assessed as competent, the task has been formally delegated by an appropriate registered professional, and the delegation is recorded within the individual’s personal plan and associated records.

It applies to all individuals receiving domiciliary care who are at risk of or have existing pressure ulcers, particularly those who are:

• Immobile or have limited movement.
• Bedbound or wheelchair-dependent.
• Elderly or frail with thin or delicate skin.
• Experiencing incontinence.
• Malnourished or have poor hydration.
• Living with chronic conditions such as diabetes or vascular disease.

3. Policy Statement

{{org_field_name}} is dedicated to delivering high-quality, person-centred care that prioritises the prevention of pressure ulcers through a structured risk assessment, prevention plan, and a responsive approach to managing existing wounds.

We ensure that our staff:

• Ensure that skin integrity and pressure damage risks are identified through the provider assessment, ongoing reviews, daily observations where required, and use of assessment tools approved by Public Health Wales or required by the relevant local health board.
• Implement evidence-based preventative measures tailored to each individual’s needs.
• Recognise early warning signs of skin damage and escalate concerns promptly.
• Work closely with healthcare professionals to manage wounds effectively.
• Escalate without delay to the registered manager, relevant healthcare professionals, the service commissioner and safeguarding agencies where pressure damage is identified, deteriorates, appears avoidable, is linked to neglect or unsafe care, or where the person’s current care arrangements no longer meet their assessed needs.
• Provide continuous training and support to ensure best practices are upheld.

4. Managing Pressure Ulcer Prevention and Treatment Efficiently

4.1. Risk Assessment and Identification

Risk assessment is the first step in preventing pressure ulcers. All service users will undergo an initial skin and pressure ulcer risk assessment upon commencement of care and regularly thereafter. The assessment will consider:

• Skin integrity – Checking for redness, skin breakdown, and other early signs of pressure damage.
• Mobility levels – Identifying individuals who are unable to reposition themselves.
• Nutritional status – Assessing for malnutrition or dehydration, which increases risk.
• Incontinence – Evaluating moisture-related skin damage.
• Use of medical equipment – Ensuring pressure points from catheters, oxygen masks, or splints are managed appropriately.

Staff must be alert to the fact that early pressure damage may present differently depending on skin tone. Redness may be less visible on darker skin. Staff must look and report other signs such as localised heat, swelling, hardness, pain, discomfort, skin discolouration, purple or blue areas, blistering, broken skin, changes in texture, or any area that feels different from surrounding skin.

Skin integrity and pressure damage risk assessments will be completed using the assessment tool approved by Public Health Wales or required by the relevant local health board. Where an individual is assessed as being at risk, staff will ensure that the person is supported in line with the SKIN bundle or any locally required pressure ulcer prevention pathway. The assessment outcome, preventative actions, escalation arrangements and any professional advice must be recorded in the individual’s personal plan, risk assessment and daily care records where relevant. Risk assessments must be reviewed at the start of the service, within the provider assessment process, whenever there is a change in the person’s condition or circumstances, following any incident or concern, and at planned review intervals.

4.2. Preventative Measures

To reduce the risk of pressure ulcers, {{org_field_name}} implements the following preventative strategies:

Repositioning and Mobility Support

• Encouraging and assisting individuals to change position regularly in line with their personal plan, moving and handling risk assessment, professional advice and agreed repositioning schedule. Repositioning frequency must be person-specific and must take account of the individual’s skin condition, comfort, mobility, support surface, pain, continence, nutrition, hydration, wishes and any clinical advice.
• Using turning schedules for those who require assistance.
• Supporting service users with safe movement and transfers using appropriate aids.

Skin Care and Hygiene

• Keeping skin clean and dry, using pH-balanced cleansers rather than harsh soaps.
• Applying moisturising creams to maintain skin hydration and prevent dryness or cracking.
• Checking for signs of redness, swelling, or skin breakdown daily.

Pressure-Relieving Equipment

• Supporting access to appropriate pressure-relieving or pressure-redistributing equipment, such as cushions, mattresses, overlays, heel protection or seating equipment, where this has been identified through assessment or recommended by a healthcare professional. Where equipment is supplied by the NHS, local authority, commissioner, family or the individual, staff must follow the agreed instructions for use and report any concerns about suitability, availability, cleanliness, damage, faults or non-use.
• Staff must not adjust specialist pressure equipment settings unless they have been trained and authorised to do so, and the action is recorded in the care record.
• Ensuring individuals are positioned correctly to avoid excess pressure on vulnerable areas (e.g., heels, sacrum, elbows).

Nutrition and Hydration

• Encouraging adequate fluid intake to maintain skin elasticity.
• Monitoring dietary intake to ensure individuals receive adequate protein, vitamins, and minerals for skin repair.
• Referring individuals to dietitians or speech and language therapists if there are swallowing or nutritional concerns.
• Where staff identify poor appetite, weight loss, dehydration risk, swallowing concerns, repeated refusal of food or fluids, or deterioration in skin integrity, they must record the concern, inform the registered manager and follow the agreed escalation process to the GP, district nurse, dietitian, speech and language therapist, commissioner or emergency services as appropriate.

4.3. Early Detection and Reporting

Care staff must monitor skin integrity in line with the individual’s personal plan, consent, assessed needs and agreed care tasks. Any concern must be recorded and reported without delay to the registered manager or nominated senior person, and escalated to the relevant healthcare professional, commissioner, safeguarding team or emergency services according to the level of risk.

• Any sign of skin redness, blistering, or open wounds must be documented and escalated.
• Photographs of skin damage or wounds must only be taken where this is lawful, necessary, proportionate and in line with {{org_field_name}}’s confidentiality, data protection, consent and records policies. The individual’s consent must be obtained and recorded wherever they have capacity to consent. Where the person lacks capacity, any decision must be made and recorded in accordance with the Mental Capacity Act 2005 and best interests principles. Photographs must not be stored on staff personal devices and must only be shared with authorised professionals through approved secure systems.
• Affected areas must be kept clean, dry, and free from additional pressure while awaiting further medical advice.

4.4. Pressure Ulcer Management and Wound Care

If a pressure ulcer develops, prompt action is required:

• Pressure damage must be identified and described using the terminology required by the relevant local health board or tissue viability service, including Category 1, Category 2, Category 3, Category 4, unstageable pressure damage and suspected deep tissue injury where applicable. Care staff must report observed signs and must not clinically diagnose or grade pressure damage unless this is within their role, training and competency.
• Referral to a GP, district nurse, or tissue viability specialist for further assessment and wound care planning.
• Dressings, wound products and wound care interventions must only be applied by staff where this is part of the agreed care package, has been delegated by an appropriate healthcare professional where required, is included in the individual’s personal plan, and the staff member has been trained and assessed as competent. Staff must follow the written wound care plan or professional instructions and must report any deterioration, pain, leakage, odour, bleeding, signs of infection, dressing displacement or other concern without delay.
• Pain management to ensure comfort and quality of life.
• Urgent medical advice must be sought where there are signs of infection, sepsis, rapidly deteriorating skin damage, uncontrolled pain, spreading redness, swelling, heat, discharge, offensive odour, fever, confusion, sudden deterioration or any other clinical concern.
• Where pressure damage appears to have developed or worsened due to possible neglect, missed care, poor nutrition or hydration support, inappropriate equipment, failure to reposition, unsafe discharge, or failure to follow professional advice, the registered manager must consider whether a safeguarding referral is required.
• Close monitoring and review of the ulcer daily until healing is observed.

4.5. CIW Notifications and Reportable Incidents

The registered manager and responsible individual must ensure that CIW is notified, without delay and in writing through CIW Online, of any notifiable event relating to pressure damage. This includes any occurrence of Category 3 pressure damage, Category 4 pressure damage or unstageable pressure damage, and any serious accident or injury to an individual.

The notification must include relevant details of the event, the action taken to protect the individual, professional advice sought, safeguarding action considered or taken, communication with the individual and/or their representative, and any immediate measures put in place to reduce further risk.

Where delegated CIW Online assistants are used, the responsible individual remains accountable for ensuring that notifications are made appropriately and within required timescales.

4.6. Collaboration with Healthcare Professionals

We work in close partnership with NHS professionals to ensure effective pressure ulcer management, including:

• District nurses for advanced wound care and dressing changes.
• Tissue viability nurses for specialist support and complex cases.
• Physiotherapists and occupational therapists for mobility and equipment recommendations.
• GPs and dietitians for medical management and nutritional advice.

All interventions and changes to the care plan will be documented and communicated to relevant parties.

Where more than one agency is involved, the personal plan and care records must make clear who is responsible for each aspect of prevention, monitoring, equipment, repositioning, continence support, nutrition and hydration support, wound care, review and escalation.

4.7. Staff Training and Competency

All care staff will receive comprehensive training on pressure ulcer prevention and management, including:

• Understanding risk factors and early warning signs.
• Correct repositioning techniques and use of equipment.
• Skin care best practices to maintain integrity.
• Reporting procedures and escalation protocols.
• Understanding staff role boundaries, delegated healthcare tasks, consent, mental capacity, safeguarding, duty of candour, CIW notification triggers, infection prevention and control, documentation, escalation and when urgent medical advice is required.

Staff must not undertake pressure ulcer assessment, grading, wound care, dressing changes or equipment adjustments unless the task is included in the person’s plan, the staff member has received appropriate training, competency has been assessed and recorded, and the task is within the limits of their role. Competency must be reviewed following incidents, concerns, changes in best practice, changes in the individual’s needs, or at least annually.

Training will be mandatory for all staff upon induction and refreshed annually. Competency assessments will be carried out to ensure staff follow best practices.

4.8. Documentation and Record Keeping

Accurate, timely and factual record keeping is essential for safe pressure ulcer prevention and management. Staff must document, where relevant:

• Skin integrity observations and any changes or concerns identified.
• Risk assessments, provider assessments and personal plan reviews.
• The agreed SKIN bundle or local pressure ulcer prevention pathway actions.
• Repositioning support offered, provided, declined or not completed, including the reason.
• Nutrition and hydration concerns, food and fluid monitoring where required, and escalation action taken.
• Continence-related skin concerns and action taken to protect dignity and skin integrity.
• Equipment in use, concerns about equipment, requests for review and any professional advice received.
• Wound care instructions received from healthcare professionals and care delivered by competent staff where applicable.
• Pain, discomfort, distress or signs of infection and action taken.
• Referrals, professional contacts, safeguarding referrals, CIW notifications and communication with the individual, representative, commissioner and healthcare professionals.
• Any refusal of care, inability to access the person, missed or late calls affecting pressure ulcer prevention, and the action taken to reduce risk.

Records must be clear, contemporaneous, confidential, securely stored and available for audit, safeguarding enquiries, professional review and CIW inspection.

4.9. Refusal of Care, Informed Choice and Positive Risk-Taking

Individuals have the right to make choices about their care, including choices that may involve risk, where they have capacity to make the relevant decision. Where an individual refuses repositioning, skin checks, equipment, nutrition or hydration support, continence care, referral or other pressure ulcer prevention measures, staff must respond respectfully and must not use coercion.

Staff must explain the risk in a way the person can understand, offer reasonable alternatives, record the refusal and the action taken, and report repeated or high-risk refusals to the registered manager. The registered manager must consider whether a review of the personal plan, mental capacity assessment, best interests process, professional referral, commissioner involvement or safeguarding referral is required.

4.10. Safeguarding and Pressure Damage

Pressure damage may indicate neglect, acts of omission, poor care, unsafe discharge, inadequate equipment, poor nutrition or hydration support, missed visits, failure to follow professional advice or a deterioration in the person’s health. The registered manager must consider safeguarding action where pressure damage is unexplained, avoidable, severe, deteriorating, recurrent, linked to missed or inadequate care, or where there are concerns about abuse, neglect or improper treatment.

Staff must report safeguarding concerns immediately in line with the Safeguarding Policy and the Wales Safeguarding Procedures. The registered manager must ensure that immediate action is taken to protect the individual, appropriate referrals are made, evidence and actions are recorded, and the individual and/or their representative is supported to understand what is happening.

4.11. Duty of Candour and Communication When Things Go Wrong

{{org_field_name}} will act in an open, honest and transparent way with individuals and, where appropriate, their representatives when pressure damage develops, deteriorates or is linked to a concern about the care provided. This includes explaining what has happened, what immediate action has been taken, what referrals or notifications have been made, what further review will take place, and what will be done to reduce the risk of recurrence. An apology will be offered where appropriate. All communication must be recorded.

4.12. Audit, Monitoring and Learning

The registered manager will monitor pressure ulcer prevention and management through regular audits of risk assessments, personal plans, daily records, repositioning records, equipment concerns, referrals, incident reports, safeguarding referrals, CIW notifications, training records and competency assessments.

Any pressure damage incident, deterioration or missed prevention opportunity must be reviewed to identify learning, immediate corrective action and wider service improvement. Themes and learning must be shared with staff through supervision, team meetings, training updates and quality assurance processes. Relevant findings must be included in the service’s quality monitoring and improvement arrangements.

5. Related Policies

This policy aligns with the following:

• Safe Care and Treatment Policy (DCW11) – Covers risk assessment and prevention.
• Infection Prevention and Control Policy (DCW17) – Ensures wound care hygiene.
• Medication Management and Administration Policy (DCW21) – Includes pain relief considerations.
• Nutritional and Hydration Needs Policy (DCW12) – Addresses dietary risk factors.

• Safeguarding Adults and Children Policy – Covers abuse, neglect, improper treatment, safeguarding referrals and Wales Safeguarding Procedures.
• Consent and Mental Capacity Policy – Covers consent to skin checks, photographs, care interventions, refusal of care and best interests decisions.
• Data Protection and Confidentiality Policy – Covers secure recording, storage and sharing of photographs, health information and care records.
• Incident Reporting and CIW Notifications Policy – Covers notifiable events, including Category 3, Category 4 and unstageable pressure damage.
• Duty of Candour Policy – Covers openness, apology, communication and learning when things go wrong.
• Moving and Handling Policy – Covers safe repositioning, transfers, equipment and staff competency.
• Continence Care Policy – Covers continence-related skin damage and dignity.
• Delegated Healthcare Tasks Policy – Covers delegated wound care or clinical tasks where applicable.
• Record Keeping Policy – Covers accurate, timely, secure and auditable records.

6. Policy Review

This policy will be reviewed at least annually, or sooner where there are changes to Welsh legislation, CIW requirements, Welsh Government statutory guidance, NICE guidance, Public Health Wales or local health board guidance, All Wales Tissue Viability Nurse Forum guidance, safeguarding requirements, incident learning, audit findings, complaints, CIW inspection findings, or changes to the service’s statement of purpose.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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