This section will guide you through the things to look out for and who you can call on for health.
Regular checks of where you can get a pressure ulcer (e.g. bottom, heels, elbows, hips, or your skin under a splint) are a core part of a safe routine to prevent pressure ulcers.
These regular checks will give you a good understanding of what is ‘normal’ for you at each skin area. This will enable you to notice if something changes so you can adapt your routine. You can include checking as part of your skin care routine (e.g. when you wash, shower or bathe).
You might have other areas that are vulnerable to pressure at different times or in different circumstances if your personal or medical situation changes. You should also check these areas.
This involves:
As well as checking your skin as part of your routine it is also important to do skin checks when something unusual happens. This might be something that makes you concerned about damage.
This could be:
Pressure Ulcers can range from red patches to deep cavity wounds and can look different in people with lighter or darker skin.
There are many ways to notice a change that may signal damage to your skin including changes in skin colour/tone, texture, temperature, sensation (If you can feel it). Click on the arrows to scroll through:
Skin tone can vary across the body. In lighter skin, you may notice pinkness, redness or darker marks that don’t fade when pressed for 6 seconds. Changes can be harder to see in darker skin, so also check for differences in texture, temperature and sensation.
You may notice changes in how your skin feels. It may become softer, firmer, dry, coarse or shinier. Some differences are normal (e.g. elbows and heels are rougher than the bottom), so knowing what’s normal for you helps you spot changes.
Your skin may feel cooler or warmer than usual.
Your skin may feel different. You may notice increased tingling, itchiness, or pain.
Skin and wounds can have an odour. This does not always mean there is an infection. A health professional can review this for you.
If your skin is broken it makes it more vulnerable to further damage.
There are several ways to check your skin. How you do this will depend on your own personal circumstances and needs. Click on the text below to find out more:
A long-handled or specialist mirror may help. You might also try using two mirrors; one near your head and one at the area you want to check.
You can ask a family member or carer to help with these checks or to check your skin for you. Showing them this guidance will help them understand what to look for.
Taking a photo of your skin can help you keep an eye on any changes over time. You can also use photos to show a health professional areas you are concerned about. You can ask your carer, personal assistant or health professional to take the photo for you, with your consent. Please do not send/upload photos of intimate areas when contacting health professionals. When taking a photo in a mirror, turn off the flash and use a well-lit room. Hold your device about half a metre away to avoid blur. Placing a ruler or tape measure next to the area can help track size and changes over time.
Sandra is a personal assistant (PA) for Tony, who has functional neurological disorder.
"When I first started as a PA, I didn’t see pressure ulcer prevention as part of my role. Over the years, I’ve realised I have an important part to play. I notice changes in Tony’s health or life that mean he is more at risk. For example, when he is unwell and moving less, I encourage him to change position and to check his skin.
An important part of my role is advocating for Tony. He finds hospital appointments quite stressful. Before an appointment, we talk about anything that’s making him anxious and how I can help. I also talk to hospital staff about what he needs and what his normal routine looks like. I make sure he has the right equipment and get him the food and drink he likes.
When Tony had a skin problem, I contacted the district nurses. I asked for an urgent appointment because I know how serious pressure ulcers can be.
Being a PA can be challenging, but I can truly say it’s the most rewarding job I have ever had. I feel like part of the family I support and want to help them.
Every PA role and relationship is different, but I would encourage people to chat about pressure ulcer prevention with their PAs. We will probably be able to help. re ulcer."
This is a fictional case study based on real experiences of real people. Details have been changed to protect people’s privacy.
If you notice changes in your risk or personal circumstances or changes in your skin it is really important to take immediate action. Taking immediate action can help prevent skin damage altogether or prevent worsening of skin damage you already have. There are three key actions you should consider:
Immediate use of our ‘toolbox’ activities which are actions you can take yourself and are detailed below: These are relevant if you notice changes in risk, the first signs of skin damage or you are waiting to see a healthcare professional about skin concerns.
Whether you need to seek outside help from a healthcare professional: You should do this straight away if you think you have a pressure ulcer or if you have risk and skin changes you are concerned about or that have not improved. Remember, this is your body and you know it best, if something doesn’t seem right then seek help.
Support to manage your concern about pressure ulcer development
IMPORTANT: if you have a pressure ulcer and become unwell seek NHS help. It could be that you have an infection that will need medical treatment.
Urgent help: Without treatment infections can lead to Sepsis, a serious illness which can be life threatening. Symptoms vary but can include confusion, slurred speech, breathing difficulties. Further information about sepsis and what to do is provided here. If you can’t use the weblink and your gut instinct is that you are really unwell and need urgent help cal 999.
Prompt help: if you notice a change in your wound (e.g. increased dressing leakage, pain or odour) or feel generally ‘off it’ (e.g. high temperature, tiredness) and your GP is open, request a same day appointment, explaining that you suspect you have a wound infection that could get worse without treatment. If during the evening or at weekend call 111 for further advice.
If you notice changes in your risk factors or personal circumstances or changes in your skin..
Immediately do the following:
If you have previously seen a health professional about pressure ulcers or your condition: Contact them in the first instance.
If you have NOT previously seen a health professional (or support is no longer available): Contact your GP. GPs are not always experts on pressure ulcers, so you may need to tell them you are worried about a pressure ulcer and why (i.e. you are at high risk). If you are unhappy with their response, then you can try another GP in your practice.
GPs are unlikely to treat your pressure ulcer themselves. Some GPs may be unsure about local services that can help. You may know more about the specialist services for your condition than a GP. If there is someone who has helped in the past, tell the GP about them.
We have provided a list of health professionals and services that might be able to help. You can take this list to your GP and discuss what is available in your local area. You can also use our resources about communication to help you express your situation, concerns and needs.
These include registered nurses who specialise in managing wounds, including pressure ulcers. They have in-depth knowledge of prevention and treatment, and can help with skin above the ankle and on the heels. If the issue is elsewhere below the ankle or may be a diabetic foot ulcer, you may need referral to podiatry.
These include registered community and district nurses who care for people at home. Their role includes assessing health needs, managing wounds, giving injections, promoting independence and helping to reduce hospital admissions.
These include teams you may already see as part of your care, such as a Neurology team. It can also include people at charities or organisations that provide specialist help and advice such as a spinal cord injury nurse specialists at a spinal charity.
Community physiotherapists can provide help to reduce pain and improve movement and can visit you in your home or local places in the community.
Can help with activities you find difficult, by looking at different ways to do these, in ways that fit with your daily life.
This service provides treatment of issues with your skin on your ankle and your feet. You may be referred to podiatry if the skin that has changes is on your foot. The skin on your heels can be dealt with by Tissue Viability Services.
These often include Occupational therapists, Physiotherapists and specialist registered nurses. They are particularly relevant if you think your current problem is due to your wheelchair or cushion as they have specialist knowledge around posture.
You might feel unsure or worried about the changes you have noticed in your skin. It is common for skin changes to happen if your physical risks change. This can also happen if your personal circumstances and situations change. You might be feeling guilty or somehow responsible for what has happened. You might feel fed up or low. This might feel different for different people. It is important that you do not blame yourself. There are many things that cause pressure ulcers and if you feel you need help and support there are people you can reach out to and contact (see links to below).
Be kind to yourself. If you feel you need to talk to others, you could talk to family and friends as well as carers, PAs about how you are feeling. You can also talk to someone else who you don’t know (see links to below). Try to do things you enjoy. Its ok to ask others for help.
You can also talk to others with the same experiences for support.
What should I do when I notice a change?
The actions you need to take depend on how serious the changes are and the level of concern you might have about the change. Completing the safe routine plan will help you think through the actions you should take.
Communicating with healthcare professionals
Explore this infographic to find practical ways to communicate with healthcare professionals, along with top tips for supporting people with pressure ulcers and those who advocate for them.
Where to get urgent help for mental health
If you would prefer a printed version, you can download the full guide as a PDF. This provides the same information in an easy-to-follow format that you can read offline, keep to hand, share with others, or take with you to appointments.
