Prevention and management of pressure ulcers in primary and secondary care: summary of NICE guidance

Pressure ulcers are serious and distressing, and they can affect people of any age. Not only do they increase mortality, result in extended hospital stays, and consume substantial healthcare resources, they are often an example of avoidable harm. Reported prevalence rates range from 4.7% to 32.1% in hospital populations and as much as 22% in nursing home populations.1 Prevention of this devastating condition must be a priority for the NHS. Stage 1 pressure ulcers (see box for definition of stages) can be reversible if identified promptly, and most stage 2 and 3 ulcers can be healed with appropriate care, but all require a multidisciplinary approach for effective management. It is hoped that this guideline will help reduce pressure ulcers nationally and improve care when pressure ulcers do occur. #### Pressure ulcer categories/stages2 ##### Category/stage 1: Non-blanchable redness of intact skin Intact skin with non-blanchable erythema of a localised area, usually over a bony prominence. Discoloration of the skin, warmth, oedema, hardness, or pain may also be present. Darkly pigmented skin may not have visible blanching. The area may be painful, firm, soft, and warmer or cooler than adjacent tissue. This category may be difficult to detect in people with dark skin tones. It may indicate that the person is “at risk.” ##### Category/stage 2: Partial thickness skin loss or blister Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. May also present as an intact or open (or ruptured) blister filled with serum or sero-sanguinous fluid. Presents as a shiny or dry shallow ulcer without slough or bruising. This category should not be used to describe skin tears, tape burns, incontinence associated dermatitis, maceration, or excoriation. ##### Category/stage 3: Full thickness skin loss (fat visible) Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle is not exposed. Some slough may be present, as may undermining, where the ulcer extends under the surface. The depth of …