Pressure ulcers Resources

This second paper in the series on the assessment and management of osteomyelitis associated with pressure ulcers focuses on diagnosis, management, and prevention within community and primary care practice. It outlines key diagnostic principles, emphasising that confirmation of osteomyelitis is typically achieved through multidisciplinary assessment rather than a single investigation, and that the primary role in community settings is to recognise, document, and escalate appropriately. Management approaches include antimicrobial therapy, surgical considerations, pressure redistribution, and optimisation of health and wellbeing. The paper also highlights antimicrobial stewardship, the importance of person-centred goal setting, and the role of palliative wound care in individuals with advanced frailty or limited healing potential. It concludes with a call for action, advocating improved multidisciplinary collaboration, greater consistency in clinical pathways, and strengthened data capture to reduce variation and support safer, more effective care.

Dementia is a syndrome occurring as a result of brain disease, which is usually chronic or progressive in nature and ultimately a life-limiting condition. As discussed in the first article in this twopart series, in addition to cognitive decline, people diagnosed with dementia will also experience a gradual loss of function with a growing inability to perform basic activities of daily living, such as feeding, toileting and dressing (Kilroy-Findley and Harrison Dening, 2025). Dementia is often synonymous with ageing so people will also experience other comorbid conditions related to age, such as the effects of ageing skin and increased risk of frailty. In the advanced stages of dementia, the person may also experience immobility and poor nutrition and hydration, all of which are significant risk factors for developing pressure ulcers. This paper considers pressure ulcers in the context of a fictionalised case study based on clinical practice of a person with dementia, and explores patient assessment and care as well as treatment of pressure ulcers, reflecting on the literature.

Good skin integrity is essential for overall health and wellbeing. The skin is the body’s first line of defence against external threats such as infection, injury, and fluid loss. Maintaining skin integrity is crucial, especially for patients in their own homes where skin observation may be less frequent than in in-patient settings. Any damage to the skin can increase the risk of complications, such as pressure ulcers, infection and skin tears. This article examines the importance of assessing risk and maintaining good skin integrity for patients, and explores the role of nurses in maintaining good skin health, outlining evidence-based interventions.

Pressure ulcers were the largest proportion of patient safety incidents in 2011–2012, accounting for 19% of all reports (National Institute for Health and Care Excellence [NICE], 2014). Developing strategies and incentives to help reduce pressure ulcer incidence by stressing the importance of improving nurses’ knowledge in areas of skin care and encouraging carers/relatives, together with patients, to take an active role has been shown to improve outcomes in reducing the development of pressure ulcers (NHS Commissioning Board, 2013). With guidance focusing on prevention as well as treatment, it is important that community services understand both the risks and how to stage pressure ulcers appropriately to provide timely and cost-effective treatment.

This article looks at some case reports undertaken during a community initiative, which explored the importance of regularly
reassessing patients’ support surface needs in relation to their general wellbeing, comfort and personal relationships on a long-term basis. The comfort and dignity of patients who are prescribed longterm specialist dynamic mattresses is discussed through real patient stories. The importance of both involving and educating patients and their carers on pressure ulcer identification and preventation is also shown through this community initiative.

With more people living longer, an increasing amount of care and support is being given in people’s homes. The Department of Health (DH, 2012) has highlighted how complex care, which was previously only delivered in hospital, is now being provided by district nursing teams and other multidisciplinary agencies.

Pressure ulcers result in pain and poor quality of life for patients as well as being regarded as an indicator of poor practice for nurses and healthcare organisations. Similarly, prevention of pressure ulcers is preferable to treatment, which can be expensive. This article considers the latest guidance on the prevention of pressure ulcers and looks at some of the innovations such as pressure relieving devices and the use of dressing products, which nurses can use to provide holistic care. Finally, the author reiterates that despite the use of guidelines and innovative products, the nurse must also rely on their clinical judgement.