New NHS Guidance on Pressure Ulcers

Updated guidance from NHS Improvement (NHSI) on the definition and measurement of pressure ulcers has recently been published with the aim of ensuring a more consistent approach to their management across the UK. Concerns had previously been raised that inconsistencies in the assessment and categorisation of ulcers had led to underreporting and a lack of clarity due to organisations using a variety of different tools.

NHSI first launched its Stop to Pressure campaign in November 2016 as part of a renewed effort to reduce the prevalence of pressure ulcers. During 2017, its work to clarify terminology and definitions helped to produce a more standardised approach, agreeing on the use of the term “pressure ulcer” as the preferred term for any pressure-related tissue injury and producing a definition of a pressure ulcer as:

“localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), resulting from sustained pressure (including pressure from shear). The damage can be present as intact skin or an open ulcer and may be painful”.

Following this initial work, the project team’s work led to the adoption of a six-category approach to the description of pressure ulcers which all health and social care services will be expected to adopt. Read on to find out more about the new NHSI descriptors and how you can ensure your service is ready for this new approach.

Pressure Ulcers

The 6 categories of pressure ulcers, agreed by NHSI, were based on those used by the National Pressure Ulcer Advisory Panel (NPUAP). As well as stages 1 to 4, familiar to most staff dealing with pressure ulcers, they include a further two stages to help identify those ulcers which have not clearly fitted into the previously used system.

The new categories are:

Category 1: non-blanchable erythema

Category 2: partial thickness skin loss

Category 3: full thickness skin loss

Category 4: full thickness tissue loss

Deep tissue injury (DTI) – depth unknown

Unstageable (US) ulcer – depth unknown

4 Steps to Adopt the New NHSI Guidance

  1. Provide staff training: Many of your staff will be reliant on the training that you provide in order to stay up to date with best practice in pressure ulcer management, so it’s essential that you make them aware of the new definitions from NHSI. You may choose to provide refresher training, hold a staff meeting to share the new information or discuss the subject at supervision but whatever your approach, all your staff should be updated.
  2. Revise your assessment tools: Your existing assessment and screening tools are unlikely to use the new 6-point system, so you should ensure they are updated to reflect this change. Remember that hospitals, community nursing teams and other services that you come into contact with will already be in the process of modernising their systems so it’s important that you align your own approach to ensure consistency and avoid confusion.
  3. Update care records: If you already have any service users with pressure ulcers, update their records to ensure that the new NHSI categories are used rather than any older systems. Agreeing a date from which the new system is to be adopted will help to provide your team with a timescale for reviewing records.
  4. Seek specialist advice: Many local authorities and clinical commissioning groups are providing additional resources to raise awareness of the NHSI’s work so don’t be afraid to ask your local tissue viability or community nursing team for help and advice.

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