Turning schedules, mattresses and the daily checks families can realistically do.
Pressure sores develop where body weight presses skin against bone for too long, most often the lower back, hips, buttocks and heels of a person who cannot shift position themselves. They are painful, slow to heal and largely preventable, and prevention happens at home, in the hands of families and carers, not in hospital.
Skin under constant pressure loses its blood supply, and after only a couple of hours it begins to die from the inside. The damage starts at the bone, not the surface, which is why a small skin mark can hide a much larger problem beneath. The whole of prevention is relieving pressure before that clock runs out, everywhere, around the clock.
Reposition a bed bound person at least every two hours, day and night: back, left side, right side, in rotation. In a chair, shift weight every hour, or teach the person to lift or lean every fifteen minutes if they can use their arms. Put a written turning chart by the bed; in tired households, memory fails at 3 a.m. and the chart does not.
A pressure relieving mattress, air or high grade foam, spreads weight and buys safety between turns; a matching cushion does the same for the wheelchair. Keep heels floating with a pillow under the calves, never a ring cushion under the heel. Use pillows between the knees on side lying. Avoid doughnut cushions everywhere; they concentrate the very pressure they claim to relieve.
Keep skin clean and dry; urine and sweat soaked skin breaks down far faster. Change wet clothing and bedding promptly, and use barrier creams where incontinence is an issue. Feed the person properly: protein, calories and fluids are the raw materials of skin, and a poorly nourished patient will develop sores under a perfect routine.
Once a day, in good light, look at every pressure point: lower back, buttocks, hips, heels, ankles, elbows, shoulders and the back of the head. You are looking for redness that does not fade within an hour of taking pressure off. That non fading redness is stage one of a pressure sore, and acting on it that same day, strict offloading of the area, usually prevents a wound entirely.
Any blister, open area or black patch over a pressure point needs medical review promptly, as does any sore that produces odour or discharge. Established deep sores are treatable with surgery, but every one of them began as a patch of redness someone could have caught. The daily check is the whole game.
At least every two hours in bed and every hour in a chair, around the clock. A written turning chart by the bed helps families share the work.
A pressure relieving air or high grade foam mattress appropriate to the person's risk. The team can advise a suitable type before discharge.
A patch of redness over a bony point that does not fade within an hour of relieving pressure. Acting that day, with strict offloading, usually prevents a wound.
The tailbone and buttocks, hips, heels, ankles, shoulder blades and the back of the head take the most pressure in bed or in a chair. These areas need checking every day in anyone who cannot shift position freely.
Poor protein intake, low fluids and anaemia all make skin more likely to break down and slower to heal. Regular meals with adequate protein, and treatment of anaemia, are part of prevention.
No. Rubbing an area that is already under stress can worsen the damage. Relieve pressure from it completely and watch it, and seek review if the redness does not fade after the pressure is removed.
If the sore deepens, shows dead tissue, smells, exposes bone, or the person develops fever or confusion, it needs surgical assessment rather than more dressings. Early review avoids a much larger operation later.
