Pressure ulcer management to support wound healing

The optimal management of pressure ulcers requires a collaborative, patient-centered treatment plan, based on available evidence, and consistent with the goals of care.¹⁻²

Management of pressure ulcers part of a comprehensive wound prevention and a wound care management approach. This starts with developing a personalised strategy for preventing and managing wounds and pressure ulcers. This includes initial evaluation and progressing towards a sustainable plan focused on the patient's self management and journey towards wound healing.¹⁻²

Managing pressure, friction and shear

Managing pressure, friction and shear forces is essential in pressure ulcer management. Managing pressure, friction, and shear in daily life can improve patient quality of life and decrease the risk that a pressure ulcer forms in fragile tissues. The management focus is on maintaining mobility while reducing these forces.¹⁻³

Management expectations may need to be adjusted in the presence of multiple factors, such as balancing the need for total offloading, plus the social, physical or psychological needs of the patient. Patient care facilities across the continuum of pressure ulcer care should have access to the appropriate equipment to meet specific patient needs.¹⁻²

Positioning someone with pressure ulcers

Positioning is an essential consideration for patients at risk of pressure ulcer formation. Frequent repositioning relieves pressure on bony prominences. Repositioning is conducted to minimise friction and shear through use of lifting sheets and positioning wedges.¹⁻²

Transfers should be assessed at the beginning, and end, of each day. Transfers tools that help reduce the forces of pressure, friction and shear, include transfer boards, trapezes, and slider sheets¹⁻²

Positioning patients for the management of pressure ulcers can be challenging, the following recommendations may help support you and your patients:

• Create a positioning schedule to manage any pressure ulcers
• Position the patient every 2-4 hours in bed
• pillows or wedges to support with positioning and body alignment

It's important to avoid positioning a patient with a pressure ulcer on bony prominences or on existing pressure ulcers.

Managing skin moisture

Managing the wound environment

Cleansing

Pressure ulcers and wounds generally and its surrounding skin should be cleansed using solutions with low toxicity such as saline, water.¹⁻²

Debriding

The method of debridement is determined based on the patient, the wound, the environment, the experience of the person conducting the debridement, and available resources for debridement (e.g. autolytic, mechanical, sharp/surgical).¹⁻²

Refashioning

Agitating the wound edge to stimulate growth of healthy skin by removing devitalised tissue, callus, hyperkeratotic debris that may be retaining biofilm.⁴⁻⁵

Dress

Using a suitable dressing is a proven final step to progress wound healing.⁴ ⁶

Moisture balance

Moisture balance within the wound base can be achieved through dressing selection¹⁻²

Learn more about the four steps of Wound Hygiene.

Key takeaways for management of patient groups with pressure ulcers

Older adults

Repositioning and support surfaces should be used to allow for pressure distribution.

Spinal cord injury

Use of seating surfaces or mattress support should be used to allow for pressure redistribution.

Critical care patients

Position patients off pressure ulcers with repositioning schedules and reduce shear.