Further information can be found in Module Four

Pressure ulcers/injuries remain a concerning and mainly avoidable harm associated with healthcare delivery. Pressure ulcers/injuries remain a challenge for the patients who develop them and the health care professionals involved in their prevention and management (NHS Improvement, 2018).

Patients must be assessed to determine their risk of pressure ulcer/injury development.

The European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA), updated their guidelines in 2019 and recommend that every individual is assessed for pressure injury risk and has received a comprehensive skin assessment as soon as possible after admission/transfer and periodically thereafter. The assessment should also be documented in the medical records.

The National Wound Care Strategy Programme (NWCSP) Pressure Ulcers 2023 recommends a risk assessment for those admitted to hospital or a care home with nursing, should be done within six hours of admission. In a community health care service, this should be carried out at the first face-to-face visit.

Risk factors include limited mobility, loss of sensation, previous or current pressure ulcers/injuries, perfusion, malnutrition and cognitive impairment. It is important to carry out the pressure ulcer/injury risk assessment at the person’s first face-to-face visit with community nursing services to ensure patient safety.

NICE (2014) noted that the pressure ulcer/injury risk status is not constant and is likely to change during the course of care. A pressure ulcer/injury risk assessment should be repeated if there is a change in a person’s clinical status. However, changes in clinical status can be difficult to define.

Specific instances where a reassessment should be carried out to ensure patient and service user safety have been identified as after a surgical or interventional procedure in hospital and after a person’s care environment changes following a transfer in any setting.

NICE (2014) also advises using a validated scale to support clinical judgement, for example, the Braden scale, the Waterlow score or the Norton risk-assessment scale. The NWCSP 2023 recommends PURPOSE-T when assessing pressure ulcer/injury risk. It also recommends reassessment of the pressure ulcer/injury risk if there is a change in clinical status (for example, after surgery, on worsening of an underlying condition or with a change in mobility).

Health care professionals should ensure they know how to assess a person’s pressure ulcer/injury risk and carry out a pressure ulcer/injury risk reassessment as recommended by NICE and as per their local policy.

For further information on pressure ulcers/injuries, please visit: and

Pressure ulcers/injuries are also covered in greater detail in Module Four.