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Pressure Care Advice 

A guide for carers and families supporting someone at risk from prolonged sitting or lying. Please do call or email our friendly trusted assessor qualified team if you require advice or to obtain any equipment whether it be to hire or buy. We can help with any products that can reduce the possibility of pressure sores from slide sheets and specialist mattresses to complex move in space wheelchairs and seating. 

1.  What is a pressure injury? 

A pressure injury (also called a pressure ulcer, pressure sore, or bedsore) is damage to the skin and the tissue beneath it, caused by sustained pressure cutting off the blood supply to that area. Without blood flow, tissue begins to break down. 

Pressure injuries can develop quickly — sometimes within a few hours — and can be very painful and slow to heal. In serious cases they can lead to infection, hospital admission, and major surgery. They are largely preventable with the right care. 

2.  Who is at risk? 

Anyone who cannot easily change their position is at increased risk. Key risk factors include: 

Risk Factor Examples / Notes 
Reduced mobility Stroke, spinal injury, severe arthritis, post-surgery recovery, frailty in older age 
Prolonged sitting or lying Wheelchair users, bed-bound individuals, long periods in one position 
Fragile or damaged skin Older age, diabetes, previous pressure injuries, dry or moist skin 
Poor nutrition or hydration Underweight, not eating or drinking enough — skin heals more slowly 
Incontinence Skin exposed to moisture becomes softer and more prone to breakdown 
Reduced sensation Unable to feel discomfort that would normally prompt a position change 
Serious illness End-of-life care, critical illness, significant medical conditions 

3.  Where do pressure injuries occur? 

Pressure injuries most commonly develop over bony areas of the body — anywhere that bone presses against a surface: 

  • Heels and ankles 
  • Sacrum (base of the spine / tailbone) 
  • Hips and buttocks 
  • Shoulder blades 
  • Back of the head 
  • Elbows and knees 
  • Ears (from oxygen masks or hearing aids) 

For wheelchair users, the sitting bones (ischial tuberosities) and the tailbone carry the greatest sustained load. 

4.  What does a pressure injury look like? 

Pressure injuries are graded in stages. Catching them early is key — early-stage injuries can heal with the right care, while later stages are far harder to treat. 

Stage 1 — Intact skin, discolouration 

The skin looks red, pink, or discoloured (in darker skin tones, look for areas that appear darker, purple, or bluish). The area may feel warm, firm, or spongy to the touch. The skin is not broken. This is a warning sign — act now. 

Stage 2 — Partial thickness skin loss 

The top layer of skin (or part of the second layer) is broken. The wound may look like a blister, shallow open sore, or raw area. This stage requires prompt attention. 

Stage 3 — Full thickness skin loss 

The skin has broken down fully, exposing the layer of fat beneath. The wound looks like a deep crater. Seek medical advice promptly. 

Stage 4 — Deep tissue and bone involvement 

Deep wound extending to muscle, tendon, or bone. This is a serious medical emergency requiring urgent healthcare input. 

Important: In people with darker skin tones, early redness may not be visible. Instead, look and feel for changes in texture, warmth, firmness, or a different shade to the surrounding skin. 

5.  How to prevent pressure injuries 

5.1  Repositioning 

This is the single most important preventive measure. Moving the body regularly relieves the sustained pressure that causes tissue damage. 

  • For people in bed: aim to reposition at least every 2 hours. Use a turning schedule if needed. 
  • For wheelchair users: encourage a small weight shift every 15–30 minutes (leaning forward, lifting slightly, or tilting the chair). 
  • Use pillows, foam wedges, or positioning aids to maintain a safe, comfortable position off bony prominences. 
  • When lying in bed, a 30-degree tilt (not flat on the back) reduces pressure on the tailbone and heels significantly. 
  • Keep heels free from the mattress by placing a pillow lengthways under the calf, so the heel floats. 

5.2  Pressure-relieving equipment 

Standard mattresses and cushions do not adequately redistribute pressure for people at significant risk. Discuss the following with a healthcare professional: 

  • Pressure-relieving mattress or mattress overlay (foam, gel, or alternating air) 
  • Pressure-relieving cushion for wheelchair or chair use 
  • Heel protectors or padded boots to off-load heel pressure 

Note: pressure-relieving equipment reduces risk but does not eliminate the need for repositioning. 

5.3  Skin care 

Keeping skin healthy makes it more resilient to damage: 

  • Inspect the skin at least daily, paying close attention to all bony prominences. 
  • Keep skin clean and dry. Pat dry gently — do not rub. 
  • Apply a light moisturiser to dry skin to maintain skin integrity. 
  • If the person is incontinent, use a barrier cream to protect skin from moisture. Change pads promptly. 
  • Avoid vigorous massage over bony areas — this can cause more damage rather than improve circulation. 

5.4  Nutrition and hydration 

Skin needs good nutrition to stay healthy and to repair itself: 

  • Ensure adequate fluid intake throughout the day. 
  • A balanced diet with sufficient protein supports skin repair and resilience. 
  • If the person has a poor appetite or is losing weight, speak to a GP or dietitian — nutritional supplements may be appropriate. 

5.5  Moving and handling 

Poor technique when moving someone can itself cause injury through friction and shearing forces: 

  • Never drag someone up the bed or over a surface — always use appropriate equipment or technique. 
  • Use slide sheets, transfer boards, or hoisting equipment where needed. 
  • Ensure any professional carers are trained in safe moving and handling. 

6.  What to do if you see a concern 

Act early 

If you notice any skin discolouration, broken skin, swelling, warmth, or a blister over a bony area — do not wait. Early treatment is far more effective than treating an established wound. 

Steps to take: 

  • Remove or relieve the pressure from the area immediately. 
  • Do not rub or massage the affected skin. 
  • Contact the person’s GP, district nurse, or healthcare team as soon as possible. 
  • If there is an open wound with signs of infection (redness spreading, warmth, swelling, odour, fever), seek medical attention urgently. 
  • In a care home or hospital, report to the nurse in charge immediately and document the finding. 

7.  When to call for urgent help 

Seek urgent help if: 

Call 111 (NHS non-emergency) or seek urgent medical review if: the wound is deep, extends to muscle or bone, shows signs of serious infection (spreading redness, high temperature, confusion, or the person seems very unwell), or if you are unsure about the severity of the wound. 

Call 999 for: 

Call 999 if someone has a severe infection, is showing signs of sepsis (rapid heart rate, high fever or very low temperature, confusion, pale or mottled skin), or is deteriorating rapidly. 

8.  Useful contacts and resources 

GP surgery Your first point of contact for skin concerns, referrals, and ongoing care planning. 
District / community nurses Can visit at home for wound assessment, dressing changes, and advice on pressure care equipment. 
NHS 111 For urgent advice when your GP surgery is closed. Available 24 hours, 7 days a week. Call 111 or visit 111.nhs.uk 
Occupational therapist (OT) Can assess for appropriate pressure-relieving equipment such as specialist mattresses and cushions. 
Tissue Viability Nurse A specialist nurse in wound care and pressure injury prevention. Your GP or district nurse can make a referral. 
Carers UK helpline Free advice and support for unpaid carers. Tel: 0808 808 7777 | www.carersuk.org 
NHS website Detailed information on pressure ulcers: www.nhs.uk/conditions/pressure-ulcers 

Please do call our friendly knowledgeable team on 01926624432 for further help and information, including equipment that may assist, see the health conditions section in our web site.