Guidelines on Prevention and Management of Pressure Ulcers

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Introduction

The purpose of these guidelines is to ensure that persons with a pressure ulcer, or who are at risk of developing pressure ulcers when using their wheelchairs, are appropriately assessed by the physiotherapist (or other appropriated health care professional) and are prescribed the most suitable equipment.

These guidelines should be read in conjunction with external guidelines produced by the National Institute for Health and Clinical Excellence and the European Pressure Ulcer Advisory Panel.

Definition of Pressure Ulcer

A pressure ulcer is ‘a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear’.

Whilst pressure ulcers are more likely to affect older people, it is now accepted that people of all ages may be affected, therefore the principles of these guidelines apply to beneficiaries of all age groups.

Classification

According to the European Pressure Advisory Panel system, pressure ulcers are classified as following:

Stage I

Nonblanchable Erythema

The skin is intact, but shows a red or dark mark, often over bony areas. The skin marking does not fade when pressure is removed, although this might be difficult to see in people with darker skin. This stage could indicate people at risk of pressure ulcers.

Stage II

Partial thickness skin loss

There is a dry, shallow, red pink wound without any dead tissue. Skin blistering (closed or open) would also fall in this category.

Stage III

Full thickness skin loss

At this stage there is a deep wound that may expose subcutaneous fat (depending on location), but not tendons or muscles. There may be dead tissue present, but the deep wound is clearly visible.

Stage IV

Full thickness tissue loss

There is a very deep wound that goes through to the muscle or tendon and might expose the bone, or the bone can be felt. Depending on location, this wound may be shallower, as there may not be any subcutaneous issue (such as on the ear or the ankle).

Unstageable: Depth Unknown

There is a deep wound but it cannot be determined, as there is a lot of dead tissue or a scab present.

Suspected Deep Tissue Injury: Depth Unknown

The skin area is intact but discoloured (purple or maroon), or there is a blood filled blister as a result from pressure or shear damage to underlying soft tissue. The area may feel painful to touch, different temperature or consistency to surrounding skin. Can be difficult to detect in people with dark skin.