Pressure Ulcers
(also known as decubitus ulcers or bedsores)
Pressure ulcers are localised damage to skin and/or underlying tissue caused by pressure, or a combination of pressure and shear. They most commonly develop over bony prominences or at sites of sustained device pressure and range from non‑blanchable erythema to full‑thickness wounds with exposed muscle or bone.
In addition to causing pain and infection, pressure ulcers are an important quality‑of‑care indicator and may trigger adult‑safeguarding concerns (NICE CG179; GOV.UK).
Pathophysiology and risk factors
- Sustained pressure compresses capillaries and impairs perfusion, producing ischaemia and tissue necrosis.
- Shear and friction increase tissue distortion.
- Moisture and maceration reduce skin resilience.
- Systemic contributors include malnutrition, dehydration, peripheral vascular disease, diabetes, sensory loss and older age.
- Patients unable to reposition themselves (bedbound, chairbound, reduced consciousness) or who have medical devices pressing on skin are at highest risk (NICE CG179; QS89).
Who should be assessed promptly
- All admitted patients or those staying in ED for prolonged periods who have reduced mobility, incontinence, poor nutrition, sensory impairment, prior pressure ulcers, vascular disease or device attachments.
- NICE quality standards expect a pressure‑ulcer risk assessment within 6 hours of hospital admission and reassessment after transfer, surgery or clinical deterioration (QS89).