Quality statement 4: Skin assessment

Quality statement

People have a skin assessment if they are identified as high risk of developing pressure ulcers.

Rationale

Whenever a person has a pressure ulcer risk assessment that shows they are at high risk of developing pressure ulcers, a follow‑up skin assessment should be carried out. A clinical assessment of the skin by a healthcare professional, taking into account any pain reported by the person, may predict the development of a pressure ulcer. The results of the skin assessment can be used to offer suitable preventative interventions to people who are at high risk of developing pressure ulcers. A skin assessment needs to be repeated whenever a person is identified as at high risk as a result of a pressure ulcer risk assessment, to take account of any changes to the skin and to ensure patient and service user safety.

Quality measures

Structure

Evidence of local arrangements to ensure that people have a skin assessment if they are identified as high risk of developing pressure ulcers.

Data source: Local data collection.

Process

Proportion of pressure ulcer risk assessments with an identification of high risk that have a follow‑up skin assessment.

Numerator – the number in the denominator with a skin assessment carried out following the pressure ulcer risk assessment or reassessment.

Denominator – the number of pressure ulcer risk assessments with an identification of high risk.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary care, community care, hospitals and care homes with nursing) ensure that healthcare professionals are trained to carry out skin assessments, and that they carry out a skin assessment if a person is identified as high risk of developing pressure ulcers.

Healthcare professionals ensure that they know how to carry out a skin assessment, and that they carry out a skin assessment if a person in their care is identified as high risk of developing pressure ulcers.

Commissioners (NHS England area teams, clinical commissioning groups) should specify that a skin assessment is carried out if a person is identified as high risk of developing pressure ulcers.

What the quality statement means for patients, service users and carers

People identified as high risk of developing pressure ulcers are offered a skin assessment by a healthcare professional to check their skin for signs of pressure ulcers. The skin assessment should be carried out every time they are identified as high risk following an assessment or reassessment of pressure ulcer risk.

Source guidance

  • Pressure ulcers (2014) NICE guideline CG179, recommendations 1.1.5 (key priority for implementation) and 1.2.3

Definitions of terms used in this quality statement

Risk of developing pressure ulcers

People considered to be at risk of developing a pressure ulcer are those who, after assessment using clinical judgement and/or a validated risk assessment tool, are considered to be at risk of developing a pressure ulcer. Risk factors include:

  • significantly limited mobility (for example, people with a spinal cord injury)

  • significant loss of sensation

  • a previous or current pressure ulcer

  • malnutrition

  • the inability to reposition themselves

  • significant cognitive impairment.

[Pressure ulcers (NICE guideline CG179) recommendations 1.1.2 and 1.2.1]

High risk of developing pressure ulcers

People considered to be at high risk of developing a pressure ulcer will usually have multiple risk factors identified during risk assessment with or without a validated risk assessment tool. Adults with a history of pressure ulcers or a current pressure ulcer are also considered to be at high risk.

[Pressure ulcers (NICE guideline CG179)]

Skin assessment for adults

A skin assessment in adults should take into account:

  • any pain or discomfort reported by the patient

  • skin integrity in areas of pressure

  • colour changes or discoloration

  • variations in heat, firmness and moisture (for example because of incontinence, oedema, dry or inflamed skin).

[Pressure ulcers (NICE guideline CG179) recommendation 1.1.5]

Skin assessment for neonates, infants, children and young people

A skin assessment in neonates, infants, children and young people should take into account:

  • skin changes in the occipital area (back of the head)

  • skin temperature

  • the presence of blanching erythema (redness on the skin that goes away when pressed with the fingers) or discolored areas of skin.

[Pressure ulcers (NICE guideline CG179) recommendation 1.2.3]

Equality and diversity considerations

Consideration should be given to people with cognitive and behavioural difficulties who may have problems reporting pain when performing the skin assessment.

Healthcare professionals should be aware that non‑blanchable erythema (redness on the skin that doesn't go away when pressed with the fingers) may present as colour changes or discoloration, particularly in darker skin tones or types.