Skin Care for PAs

If you care for someone who spend most or all of their time in a chair, wheelchair or bed, reducing the risk of pressure ulcers (often referred to as bedsores) needs to be a high priority.

It is your responsibility to constantly check for the early signs. A pressure ulcer can develop in only 20 minutes. It usually starts with the area of skin appearing redder or darker than usual. If untreated it can develop into a deep hole in the flesh which can then take weeks or months to heal, and can even be life threatening.

It’s extremely important to discuss with how and when your employer would prefer you to check for these early signs of pressure. It is your job to ensure you are respecting their dignity and comfort at all times.


What is a pressure ulcer?

A pressure ulcer is an area of damaged skin caused by:

  • Sitting or lying in one position for too long without moving
  • Dragging or rubbing skin when moving.

The areas most likely to develop a pressure ulcer where the bone is close to the surface or areas that take the weight of the body.

The person you are looking after may need help to check their skin for damage at least once a day. You need to check over any bony prominence that has been in contact with bed, chair and floor or has been in contact with other parts of the body.

If the person you’re caring for is experiencing pain or soreness in an area then an urgent check of this area is needed. For people who have had a spinal cord injury and who cannot feel these parts of their body the beginnings of a pressure sore may be indicated by increased spasms.


What to look for

  • Is there any change in colour?
  • Is the area warm to touch and surrounding skin?

Follow the traffic light pressure ulcer risk assessment:

  • Green
    The area goes pale under light fingered pressure and the redness resolves within 5 min when the pressure has been relieved.
    Promote and encourage movement, offer assistance if needed, continue skin checks twice a day.
  • Amber
    The area goes pale under light fingered pressure and the redness resolves within 10 – 15 min when the pressure has been relieved.
    Review how often the person you are caring for changes position in a one-hour period
    Continue with skin checks 3 times a day
  • Red
    The area does not pale under light fingered pressure and last for longer than 20 min once the pressure has been relieved.
    Seek urgent medical attention
    Keep the pressure away from the area until it returns to normal colour skin
    Check regularly


How to avoid getting a pressure sore

For someone confined to bed:

  • Help them to change position at least every 2 to 3 hours, alternating between lying on their back and on their side.
  • Always use always use correct moving and handling techniques to prevent injury to your back and the person you are moving.
  • Use pillows to stop the skin between the persons knees and ankles rubbing together.
  • Make sure there are no creases in the sheets

For someone spending most of their time in a wheelchair or armchair:

  • Help them to take the weight off their bottom every 15 minutes by leaning forward; moving from side to side by rolling from cheek to cheek. Do this for the length of time it takes you can slowly to 15. Do this 4 times.
  • Most wheelchair users will use a pressure cushion but they need to make sure this is properly maintained and properly fitted to be most effective.
  • Support the person to eat a healthy diet, with small regular snacks to maintain their blood pressure, nutrition and health and well-being – all of which will help to keep the skin in better condition.

Support the person to M.O.V.E

  • Make time to leave your seat
  • Off the chair move your feet
  • Vary position from sit to stand
  • Every movement is a helping hand


Beware talcum powder!

It can be tempting to use talcum powder, but it should never be used on any part of the body as it dries the skin and can act as an irritant.


If all else fails…

Even when you are helping the person you care for to do everything possible to prevent a pressure ulcer, they may still develop as a complication of their illness. If this happens you must encourage the person to seek urgent medical attention.


Further information and advice

NHS choices page on pressure ulcers