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Pressure ulcers/injuries are well known for being a common problem in healthcare and are a key indicator of the quality and experience of patient care. This article discusses how one NHS trust reduced the incidence of heel pressure ulcers within adult inpatient settings. In 2016/17, the trust identified 14 avoidable category 3 and above pressure ulcers/injuries in inpatient settings, of which 10 had developed on the heels. Through root cause analysis, the organisation identified themes, which prompted action, and a quality improvement project ‘Deal with heels’ was planned and implemented. Changes were introduced through a collaborative and structured approach; the key stakeholders included the tissue viability team, procurement, medical devices, patient safety, managers, matrons, ward sisters and tissue viability link advisors, who worked together to reduce heel ulcer prevalence through education and standardised practice. As a result of improved organisational awareness and some changes, the number of heel pressure ulcers/injuries reduced to two over a 3-year period, which also helped reduce the total number of avoidable pressure ulcers/injuries.

Pressure ulcers are increasingly seen as an untoward event for patients. While there has been a strong focus on patients in the acute sector, community services have also had to be increasingly innovative in addressing this issue. Carers in care homes in the London borough of Barnet were identified as needing additional support to improve their knowledge and skills surrounding pressure ulcer prevention and treatment. An informal pilot training session showed that carers felt better equipped in terms of identifying new pressure ulcers and were able to escalate issues to district nurses in record time. Subsequently, there was a noticeable reduction in the reporting of pressure ulcers of categories 2 and above. In the present article, the authors describe the quality improvement project undertaken at Barnet care homes to prevent pressure ulcers.

Pressure ulcers have been part of illness for thousands of years and are not reducing in number. Traditionally, since the Crimean War, patients have been ritually repositioned every 2 hours, regardless of the individual need. Pressure ulcers occur mainly on bony prominences, and so it makes sense to reposition into the 30 degree tilt, off of bony prominences. Nevertheless, this still takes time in order to reposition on a regular basis. It is time to look at automatic repositioning, reducing nursing time, increasing patient comfort and releasing carers to provide more social support to the patients.

Good skin integrity is vital to good health because the skin acts as a barrier to microbes and toxins, as well as physical stressors such as sunlight and radiation. It is well known that the skin loses integrity with the ageing process, and this makes older adults susceptible to pressure injury. Additionally, older skin takes longer to heal where there are injuries or breaks. This article looks at what skin integrity is by briefly outlining the physiology of the skin. It discusses how skin integrity can be impaired, what can be done to maintain skin integrity and skin health, and why skin integrity is important for pressure ulcer prevention. Some of the factors that can make skin care difficult are discussed, in addition to the role of community nurses in helping patients engage in skin care. The article outlines how community nurses can identify when there is skin integrity risk or damage and support patients and carers or relatives, in maintaining skin integrity.

Pressure ulcers, a key quality of care indicator, cause emotional distress to the patient, affecting quality of life. They also have significant financial implications for the NHS. Pressure ulcer prevention and management are fundamental aspects of nursing. This article reports on the Wirral Community Trust's policy and guidelines for the maintenance of skin integrity. Tissue viability nurses have a duty to review and assess new prevention devices and dressings as they become available to ensure a high standard of care is provided. A report of an evaluation of the use of KerraPro in combination with current best practice guidelines for the prevention or treatment of pressure ulcers is provided. The author concludes that silicone pressure-reducing pads are a valuable tool in the prevention and treatment of pressure ulcers when used in combination with recommendations from the latest guidelines.

If pressure damage is identified and addressed at an early stage, it may be reversed. Otherwise, it may quickly progress into a serious deep tissue injury. In the community, most daily skin care is undertaken by formal and informal carers. They therefore need to know how to identify signs that pressure ulcers may develop and what immediate actions to take. NICE guidance on pressure ulcer prevention is too extensive to be a simple tool for carers, so a SSKIN bundle was adapted for community use. This ensures carers know how to prevent and identify pressure damage, and includes skin care, repositioning and use of equipment. Carers need training. This is the responsibility of all involved with the patient, including health-care and local authority services.

Pressure ulcer prevention and management remain a challenge across all health-care settings, and the incidence and prevalence of pressure ulcers in nursing homes and residential homes continues to remain unknown. The use of suitable support surfaces has been found to be beneficial in the prevention and management of pressure ulcers. Carrying out a holistic assessment of the patient and recording the patient's at-risk score would help the clinician to determine the most suitable pressure-relieving surface for the patient. The clinician's clinical experience and judgment are also important. The Domus Auto (by APEX) mattress system and Dynamic Seat Cushion (by APEX) are effective dynamic, support surfaces in the prevention and management of pressure ulceration. They meet the recommendations by both national and international guidelines; they also partly fulfil the SSKIN bundle. From a four-week evaluation carried out in a nursing home, it has been demonstrated that, together with regular assessments and repositioning of the patients, these devices are useful tools in preventing patients' risk of tissue damage and improving the patients' quality of life.

Wound care is a complex area, and there are several factors that can influence the choice of dressing. These factors include: the care setting, type of wound, desired frequency of dressing change, and estimated duration of treatment. Further, dressing choice can be influenced by complications such as wound infection. In addition, when choosing a dressing, clinicians providing wound care need to consider the following factors: wound bed characteristics; ease of dressing application and removal; conformability; exudate management; dressing wear time; and tolerability by the patient, including the effect on lifestyle and quality of life. If all these factors are taken into account, patients are more likely to be concordant with treatment and a positive outcome achieved. For these reasons, a holistic approach to care can inform dressing selection. There are six case studies of patients presenting wounds that showed improvement after treatment with dressings from the Allevyn Gentle range.

This article discusses the aetiology of pressure ulcers, the clinical and financial cost of pressure ulcer prevention and the need for pressure reducing equipment. The role of Dry floatation in pressure ulcer prevention and management is explored. How Dry floatation technology works is discussed and its use within clinical practice is highlighted. The evidence to support Dry floatation is presented.

An evaluation of the Repose® heel pressure ulcer prevention system was conducted in an orthopaedic setting to establish its clinical efficacy in reducing the incidence of heel pressure damage, following a literature review of appropriate pressure-reducing devices. The study involved patients from a 24-bed orthopaedic ward over a six-month period. The results showed that the use of the heel protector led to a significant reduction in the incidence of heel pressure ulceration from more than 6% to 0%. A significant reduction in cost was also identified. The results indicate that the use of a heel protector alongside individualized pressure ulcer prevention has a significant impact on preventing heel pressure damage.

Any product, once CE marked and licensed, can be used to treat a patient. The question is how do practitioners make that choice? And once made do we share our experiences of using the product with others? The purpose of this product evaluation is to test the Sidhil Trio mattress in the ‘real world’. Two nursing homes used the mattress as part of their pressure ulcer prevention care for a maximum of 12 weeks with a total of 13 residents. During this time the staff and residents were asked about what they thought of the mattress and how well they felt it performed as users. Skin assessments were also undertaken weekly to assess the primary function of the mattress; does it help in the prevention of pressure damage. Of the 13 residents one developed superficial pressure damage but other residents did improve. Other positive functions of the mattress design were found; the hinged section allowed residents to sit up in bed while maintaining a therapy function and the ‘solid’ side panels gave stability for residents when sitting on the edge of the bed.

A study conducted in Sunderland investigated how staff in a private sector care home manage pressure ulcer prevention and what staff perceive to be the reasons why residents in their care develop pressure ulcers. It also identified how using a collaborative action research study design (utilizing an action research cycle with collaborative focus groups) can bring about an improvement in practice, by allowing the staff to reflect on and analyse the way they work and develop and implement strategies to provide solutions to the problems they identify.

The Waterlow pressure ulcer risk assessment system has been in use for 20 years. In this article, Judy Waterlow describes how it can be used in the community, discusses the recent update to the system and explains how pressure ulcer risk assessments should be conducted.

This article describes how a community health-care trust achieved a reduction in acquired pressure ulcers. Commissioning for Quality and Innovation 2014/15 guidance states that provider organisations should work with their partners across their local health and social care system to address the causes of pressure ulcers and reduce their prevalence, regardless of source. Gloucestershire Care Service NHS Trust was challenged to reduce the number of acquired pressure ulcers by 17% in 2013–14. The challenge for the three members of the tissue viability team was to train the qualified and unqualified staff within seven community hospitals and district nurse teams from 85 GP practices, covering a population of 600 000 within 4 months. Staff shortages and a lack of venues available meant that an adaptive educational approach was necessary. A dedicated programme of educational support from both the tissue viability nurse and an industry partner enabled the delivery of a wide range of educational materials to staff across the county. As a result of this partnership working, there was a reduction of category 3 and 4 pressure ulcers, and an increased awareness of the initial stages of pressure ulcer development demonstrated by an increase in grade 2 pressure ulcers.

Pressure ulcer prevention and management continue to be a major challenge for healthcare professionals. The problem is frequently compounded by a lack of access to appropriate resources, especially for those caring for patients in their own homes or in residential and nursing homes (Moody, 1998). Qbitus Products comprise a comprehensive range of static, pressure-relieving and postural control cushioning which is available at reasonable cost. Qbitus has the ability to produce virtually anything possible in foam, from sketches or drawings, to meet a specific patient care request. The production facilities enable the company to provide a rapid customer-focused service that includes the provision of additional covers in a wide range of materials and colours, as well as a range of special purpose control aids designed for comfort and support such as harnesses.

Heel pressure ulcers are the second most common site for pressure ulceration; although their assessment and treatment can be complex, and they often require additional consideration over and above core principles of pressure ulcer prevention and management. Recent international pressure ulcer prevention and treatment guidelines developed jointly in Europe and the USA have provided greater clarity by achieving international consensus on how to care for patients at risk of heel pressure ulceration, and also on the management of such patients if a pressure ulcer develops. Health professionals should embrace these guidelines and embed them in their everyday clinical practice and within local guidance and protocols to ensure that patients are provided with evidence-based care supported by international collaboration and agreement.

As a nurse/ward manager I always had a passion for preventing pressure ulcers. In 1993, in light of the Touche Ross report highlighting costs of pressure ulcer prevention and treatments, the Trust where I was working wanted to assess the extent of the pressure ulcer problem and develop a strategy to reduce harms to patients and costs to the Trust. I was appointed within the project team for a secondment to ascertain and baseline the number of pressure ulcers within the Trust and scope what equipment we had and what was needed. I quickly developed a real passion for working in wound care—making a difference and preventing pressure ulcers. I then became involved in assessing wounds other than pressure ulcers (much to my boss’s annoyance!).

This article explores the practical implementation of the NICE (2005) guideline on pressure ulcer prevention by those that the guideline was created for, including: service managers, commissioners, clinical governance and education leads, patients/carers and both the specialist and non-specialist.

This article aims to examine the prevention of pressure ulcers in the community. Pressure ulcers continue to cause needless distress and anxiety for patients, carers and their families. Health professionals in the community often face extreme challenges when caring for patients who are at risk of developing pressure ulcers. This could be due to lack of appropriate assessment skills and having insufficient time to conduct an appropriate assessment. Having an understanding and awareness of the function of the skin and the aetiology of pressure ulcer development can assist the health professional in attempting to take a proactive approach to prevent pressure ulcer formation in the community setting.

This month sees the 10th Anniversary Meeting and Conference of the European Pressure Ulcer Advisory Panel with both European and International speakers providing a wealth of education and research in respect of pressure ulcer prevention and management. This promises to be a significant event in terms of adding to the evidence base in this field but also in respect of the ongoing debate regarding Grade-2 Pressure Ulcers. It is anticipated that both Commissioners and Providers of Services are represented at this conference to ensure optimum care for patients across the primary and secondary care interface.