Pressure ulcers/injuries are areas of localised damage to the skin and/or underlying tissue, usually over bony prominences or related to a medical or other devices, resulting from prolonged pressure or pressure in combination with shear (EPUAP, 2019).
Typically, they occur in a person confined to bed or a chair by an illness and as a result they are sometimes referred to as ‘bedsores’, or ‘pressure sores’. All patients are potentially at risk of developing a pressure ulcer. However, they are more likely in people who are seriously ill, have a neurological condition, impaired mobility, impaired nutrition, poor posture or a deformity (NICE, 2014).
The National Wound Care Strategy Programme (NWCSP) was commissioned by NHS England to improve the prevention and care of pressure ulcers, leg and foot ulcers and surgical wounds. Below are their recommendations.
NWCSP-PU-Clinical-Recommendations-and-pathway-final-24.10.23
Prevention and management
Pressure ulcers present a major health care challenge. It has been recognized that pressure ulcers place a huge financial burden on the health care system and additionally result in a poor quality of life for the patient with an increased risk of morbidity. It is also known that many pressure ulcers are avoidable.
Efforts to reduce occurrence of pressure ulcers need to focus on prevention rather than cure. If we are to manage rates of pressure ulceration best practice needs to be employed by the use of guidelines, educational support and provision of appropriate equipment.
Nice guidance (2104) recommends using a validated scale to support clinical judgement when assessing pressure ulcer risk.
Purpose T
On the 1st April 2026 the Trust’s revised Policy for the Prevention and Management of Pressure Damage comes into effect and the PURPOSE-T pressure ulcer risk assessment tool will replace the Braden tool within the Trust.
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- PURPOSE-T-OHFT-ADULT-version-FINAL-March2026
- PURPOSE-T-Paediatric-OHFT-FINAL-March-2026-editable
- PURPOSE-T user manual (version 2) – adults
- NWCSP Clinical Recommendations – the Clinical Pathway
- NWCSP Clinical Recommendations – the aSSKINg Framework
- RIO PURPOSE-T Primary and secondary prevention care pathway assessment & care plan FINAL
Purpose T Launch training:
For Oxford Health staff, if you are not able to attend the live launch training sessions, please watch the recorded training which is available via your L&D login Oxford Health NHS Trust: Log in to the site
Resources
The following documents are available to clinicians to assist in pressure ulcer prevention and management:
- The 30 degree tilt
- DoH definition of avoidable and unavoidable pressure damage
- Pressure-damage-categories-EPUAP V4
- Moisture lesion diagnosis
- Mucosal Pressure Ulcer Position Statement
- Guidance for Categorising Deep tissue Injury and unstageable pressure damage
- Pressure ulcers and the interface with a safeguarding enquiry
- Pressure ulcers safeguarding appendix (002)
- SCALE guidance V5 August 2022
Other documents found elsewhere on this site that may be useful include:
- Oxford Health Pressure Area Care Leaflet
- Oxfordshire Community Pressure Relieving Equipment Leaflet
- Role of dietary factors in TV and wound Healing
- A variety of food fortification leaflets
- Skin Inspection – Guidance & Form