Nutrition and hydration

These resources from NHS Improvement on using nutrition and hydration to reduce the incidence of pressure ulcers and promote good wound healing, include evidence and recommendations for assessment and action when assessing an individual’s risk of developing a pressure ulcer; five top tips to prevent pressure ulcers; and three case studies.

Safeguarding adults protocol: pressure ulcers and the interface with a safeguarding enquiry

This guidance from the Chief Social Worker helps practitioners and managers across health and care organisations to provide caring and quick responses to people at risk of developing pressure ulcers.

Rexmyelocel-T for critical limb ischaemia in patients with diabetes mellitus

The treatment, rexmyelocel-T, is being developed to relieve leg pain at rest and heal leg ulcers. The treatment uses cells from bone marrow which are injected into the damaged blood vessel, where they restore existing blood vessels and create new blood vessels. By improving the blood flow in the limb, this treatment aims to improve the patient’s condition so that they do not require amputation.

From the NIHR Innovation Observatory

Mepilex Border dressings for preventing pressure ulcers [MIB124]

New: Medtech innovation briefing


The technology described in this briefing are Mepilex Border dressings, specifically the 2 variants designed to prevent pressure ulcers (Mepilex Border Heel and Mepilex Border Sacrum).

The innovative aspects are that the dressing is designed to reduce pressure and friction caused by patient movements. It also uses the company's proprietary Safetac technology, which is intended to minimise pain when changing dressings or inspecting the skin.

Educating and campaigning for pressure ulcer prevention

Wounds UK 13 (3)

This article highlights the successful efforts of the Tissue Viability team at the University Hospital Coventry and Warwickshire (UHCW) in reaching out to clinical staff in order to make progress in preventing pressure ulcers. The author describes how staff, with an interest in pressure ulcer prevention, are chosen to act as a link between the Tissue Viability Team and other clinical colleagues. After a short training, these link workers pass on brief 10-minute (power) training without having to leave their individual clinical setting, focussing on the key messages to: Assess, Surface, Keep moving, Incontinence and Nutrition (ASKIN). All of which helps to reduce in the incidence of hospital-acquired pressure ulcers.

UHCW Research: Rachel Reece

National ‘Stop the Pressure’ Programme Update: May 2017

Developments in the ‘Stop the Pressure’ programme likely to affect you in the coming months are:

• a revised approach to reporting and measuring pressure ulcers
• use of the Patient Safety Thermometer
• a pressure ulcer national audit tool
• the launch of an improvement collaborative
• active support in sharing of good practice
• a new pressure damage curriculum.

Four projects testing innovations to improve care for older people

Four projects, funded through The Health Foundation's Innovation for Improvement programme, are using new and interesting approaches to improve care for older people. Some of these projects are at the early stages of their development but have promising ways to improve care.

National Diabetes Foot Care Audit Report 2014-2016

The National Diabetes Foot Care Audit (NDFA) is a measurement system of care structures, patient management and outcomes of care for people with active diabetic foot disease.

Key messages

• Structures – The basic framework for effective prevention and management of diabetic foot disease is often missing. 
• Processes – People with new foot ulcers who get to the specialist foot care service quickly, do best
•  Outcomes – Six months after first expert assessment one third of people still have unhealed ulcers. 

Report highlights need for early intervention for diabetic foot ulcers

A report published by NHS Digital and Diabetes UK finds that early intervention is important in the management of diabetic foot disease, with people who receive expert care most quickly having the best outcomes.

It also reports that the basic framework for effective prevention and management of diabetic foot disease in England and Wales is often missing.

Perioperative antibiotics for patients with ulcerated skin cancers undergoing dermatological surgery in the U.K.: A nationwide survey of current clinical practice

British Journal of Dermatology. Conference: 96th Annual Meeting of British Association of Dermatologists. United Kingdom. Conference Start: 20160705. Conference End:20160707. 175 (pp 114-115), 2016. Date of Publication: July 2016.

The postoperative wound infection rate following dermatological surgery is approximately 2% (range 0.5-8%) (Futoryan T, Grande D. Postoperative wound infection rates in dermatologic surgery. Dermatol Surg 1995; 21: 509-14).  Factors that increase the risk of wound infection include anatomical location, tumour ulceration and patient-associated factors, such as immunodeficiency, diabetes and smoking. The role of prophylactic antibiotics to prevent infection following excision of ulcerated skin tumours has not been investigated, and no consensus guidance exists. Concerns about antibiotic resistance highlight the need for high-quality evidence to justify their use. We undertook a nationwide survey evaluating current U.K. clinical practice to explore the feasibility of designing a randomized controlled trial in this area. 

UHCW Research: Harper, N. 

Feasibility analysis to evaluate the role of perioperative antibiotics in reducing infection rates in ulcerated skin cancers

British Journal of Dermatology. Conference: 96th Annual Meeting of British Association of Dermatologists. United Kingdom. Conference Start: 20160705. Conference End: 20160707. 175 (pp 123), 2016. Date of Publication: July 2016.

Ulcerated skin cancers are commonly excised by dermatologists; however, their frequency in routine U.K. dermatological surgical lists is unknown. The presence of ulceration caused by tumour invasion may be associated with up to threefold increased risk of postoperative wound infections (Penington A. Ulceration and antihypertensive use are risk factors for infection after skin lesion excision. ANZ J Surg 2010; 80: 642-5). While high-quality evidence for this association is lacking, some dermatological surgeons consider clinical ulceration to be an indication for perioperative antibiotic use. The role of antibiotics in preventing infection in ulcerated skin lesions remains unclear, and in the absence of randomized controlled trial (RCT) data supporting their use, we aimed to evaluate the feasibility of developing such a trial. A prospective evaluation of patients undergoing excision for suspected skin tumours over a 3-week period was undertaken at two U.K. dermatology centres. The aim was to determine rates of ulceration in this cohort and to ascertain eligibility for a proposed RCT examining the role of perioperative antibiotics in excision of ulcerated skin cancers.

UHCW Research: Harper N.

Let’s work together to stop the pressure

NHS England is co-ordinating a new ‘Stop the Pressure’ improvement programme to build on the efforts Trusts have already made. The original programme led to a 50% reduction in pressure damage. Our relaunch will build on the tools, knowledge and skills from this as well as linking in with other pressure damage programmes. It will run across acute and community settings in collaboration with key partners in social services and care home settings.

Long lasting ulcers below the knee are more common than previously thought

Long lasting leg or foot ulcers, those that take more than six weeks to heal, affect about 15 in every 10,000 people. This estimate was higher than expected. Based on the previous state of knowledge it was thought that 5 in every 10,000 people, at any one time, had open leg ulcers. The researchers thought these estimates were imprecise and wanted to improve them.

This research, undertaken as part of the NIHR-funded programme, included eleven new and updated reviews of the existing literature, a survey and interviews with people with complex wounds, their carers and healthcare professionals.

From the NIHR Dissemination Centre

Hospital acquired foot ulcers reduced by 50 per cent since diabetes inpatient audit launched

Clinical audit shows a significant fall in foot ulcers but few changes in other patient harms and a continuing lack of specialist staff in many hospitals.  Only 1.1 per cent of inpatients with diabetes developed a new foot lesion during their admission to hospital, a significant decrease from 2.2 per cent when inpatient auditing began in 2010.