Nursing Opinion

Stop the pressure and improve care

Ruth May is Chief Nursing Officer for England

Almost two-thirds (60%) of people living in residential and care homes are at risk of pressure ulcers, and 20% will go on to develop them.  

Pressure ulcers are injuries to the skin and underlying tissue caused mainly by prolonged pressure on the skin – and most are preventable.

That’s why I encourage you to get involved in our Stop the Pressure campaign, which works with frontline staff to improve standards and reduce harm.  

Pressure ulcers are a key indicator of the quality of a person’s care: to prevent them, all health and care professionals (including social workers) involved in planning, commissioning and delivering care must be able to spot the risks and take speedy action.  

The Health Improvement Network database, which contains anonymised GP patient records from over 500 practices, shows that 153,000 people (7%) had pressure ulcers in 2012/13.

Other estimates are higher. Between 400,000 (Posnett et al 2018) and 700,000 patients a year across the UK develop pressure ulcers (Patient Safety First 2013), with the estimated cost of treating them standing at £1.4 million a day (Guest et al 2017).  

For every ulcer that develops, a person will suffer pain and discomfort. For the most severely affected – or if they are already frail from other medical conditions – a deep pressure ulcer can be life-threatening.  

Since 2012 the national Stop the Pressure programme (nationally from 2016) has worked with frontline staff to improve care standards across acute, community and mental health settings. Its prime objective is to reduce pressure development through focused workstreams. The National Wound Care Strategy for England, launched in September 2018, includes Stop the Pressure’s work. The strategy is a crucial way of sharing work on preventing pressure with staff in primary care and domiciliary settings and developing new strategies.

Pressure ulcers occur everywhere, from people’s own homes to acute hospitals. So it’s important that everyone in contact with people at risk can advise on preventing them and identify and act when pressure damage does occur. All health and social care staff should be aware of certain risk factors: for example, limited mobility, loss of feeling in part of the body, someone having had a pressure ulcer before, people who have not eaten well for some time, and those with a significant cognitive impairment such as dementia. At each contact, using prompt questions helps in assessing people in their own home or elsewhere.

Involving people and their carers is crucial: offer them written or verbal advice, so they are informed about what they can do to prevent damage – for example, by changing position or being aware of their diet. NICE (2014) suggests providing information about what causes pressure ulcers, early signs to look for, how to prevent ulcers, the effect of having a pressure ulcer on the person’s health, and how to use any equipment needed to change position.  

Collectively we can make a difference to our clients and patients and to those yet to access our services, by reducing the level of pressure ulcer formation. So get involved in our Stop the Pressure campaign. Reducing by 10% the lowest reported pressure ulcer numbers would mean that 15,000 people a year would not suffer the pain and potential complications that affect their daily lives. That would be a significant achievement.



Edel Harris





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