The View from Where I Sit

Tag: stop the pressure

  • The Pressure Ulcer Research Service User Network (PURSUN)

    Between 2008 and 2010, PPI was limited by the ability to recruit service users. Following the establishment of PURSUN UK in late 2010, involvement activities increased across the programme. Furthermore, the methodology and focus of each work package have guided the nature of involvement.

    The Pressure Ulcer Research Service User Network UK (www.pursun.org.uk) has a minimum of two management meetings a year at which a core group of the most active members consider the direction of the network, the terms of reference, recruitment, the website and other network materials. Research involvement opportunities are sent out by way of the mailing list, as they arise. For example invitations to help interpret data, become co-authors or input into the study methods.

    All members of PURSUN UK are prepared for involvement through a minimum of one induction meeting with the PPI officer (either in person or by telephone). During this meeting, service users are encouraged to discuss the skills and experience that they bring to the group, as well as any support that they may need.

    The value of the Pressure Ulcer Research Service User Network UK to the service users involved

    As a PURSUN researcher, I have definitely benefitted from the virtual conferences, Zoom calls and emails about Pressure Ulcer Prevention at Home, pressure relief and an app to help people with general healthcare. I’ll also be joining a focus group and I’ll be partly responsible for creating an app to ‘stop the pressure’. Delia Muir and Holly Schofield take turns leading the Zoom calls. I started my role as a PURSUN researcher in 2020, and I believe that Bermuda needs to be included in the network and the impact that it is making. Maybe I should start a sister branch there.

    Wider impact of the Pressure Ulcer Research Service User Network UK

    In addition to PPI throughout the programme, PURSUN UK has begun to impact the wider tissue viability and PPI communities. For example, members of PURSUN UK have been invited to speak about their experiences at several events.

    Locally, this has included training for tissue viability link nurses, presenting to PURPOSE principal investigators, speaking at the launch of the NIHR Bradford Wound Prevention and Treatment Healthcare Technology Co-operative and working with medical students. Nationally, members have presented at the Tissue Viability Society conference, tissue viability education events and the INVOLVE (a national PPI advisory group) conference.

    They have developed an effective model for presenting service users’ experiences in which the PPI officer, interviews a member of PURSUN UK in front of a live audience. This provides an alternative to a traditional presentation for people who do not feel confident presenting personal experiences in that way. This model has received very positive feedback from both audiences and the service users involved. They have found that real-life stories are extremely powerful and can create a common focus for professionals from a variety of backgrounds.

    Collaboration with industry

    Medical devices also play an important role in pressure ulcer prevention and treatment. With this in mind, PURSUN UK has collaborated with industry partners on projects such as education days and product development workshops. This collaboration has helped to diversify the involvement opportunities offered to PURSUN UK members and has been useful in terms of members’ personal development, as it has given people an insight into another aspect of tissue viability research. This work has also generated some funds for PURSUN UK, moving the network towards a sustainable model post PURPOSE.

    Developing and sharing patient and public involvement methods

    • the use of role play and video to facilitate PPI in the interpretation of data from the severe pressure ulcer study
    • the adaptation of the Patient Learning Journey model for use in a research context
    • the use of a live interview model as an alternative to traditional presentations
    • the addition of a service user group to the consensus methodology used in the risk assessment study
    • individualised support for steering committee members, including one-to-one debriefs with the PPI officer
    • the integration of service user narratives into the dissemination of the quantitative pain studies.

    Further developments include a completely new service user network, which has given them the opportunity to be creative in their approach and develop innovative involvement models. These models have been shared with the UK PPI community. The PPI model used as part of the severe pressure ulcer study, has been presented at three national conferences (Involving People Wales and Tissue Viability Society) and forms part of an INVOLVE video resource on PPI in data interpretation and analysis [see www.invo.org.uk/resource-centre/conference/involve-conference-gallery/ (accessed 20 February 2015)].

    A video about the Severe Pressure Ulcer PPI event was also made by PURSUN UK and has been widely disseminated online [see https://youtu.be/bgg6zkbILrg (accessed 21st July 2015)]. The novel approach of using the Patient Learning Journey as a model for service users contributing to research rather than health education has also been included as a case study in the INVOLVE training and development guidelines [see www.invo.org.uk/training-case-study-13-2/ (accessed 20 February 2015)].

    Supporting further research

    http://medhealth.leeds.ac.uk/info/423/skin/1717/pressure_2 (accessed 31 August 2015). www.jlapressureulcerpartnership.co.uk (accessed 20 February 2015).

    A website has been developed by PURSUN UK www.pursun.org.uk (accessed 20 February 2015).

    In addition, PURSUN UK has contributed to the international consensus document Optimising Wellbeing in People Living with a Wound, published by Wounds International www.woundsinternational.com/clinical-guidelines/international-consensus-optimising-wellbeing-in-people-living-with-a-wound (accessed 20 February 2015).

    Working with service users has also enabled them to more effectively engage with local and national media. Yorkshire Evening Post www.yorkshirepost.co.uk/news/at-a-glance/general-news/yorkshire-group-spearheads-bedsores-care-drive-1-3786988 (accessed 20 February 2015).

    Daily Mail www.dailymail.co.uk/health/article-2093904/Bed-sores-How-does-local-hospital-compare.html (accessed 20 February 2015).

    https://www.ncbi.nlm.nih.gov/books/NBK321107/#s2-5

  • Stop the Pressure: Pressure Ulcer Prevention and Management Virtual Conference

    I learned alot at this year’s Healthcare UK Conference. It started at 10:00 with the Chair’s Welcome and Introduction. Then at 10:20, I learned about The New National Pressure Ulcer Surveillance System. At 11:00, they discussed Supporting Learning with frontline staff in pressure ulcer prevention. By 11:30, I had a Comfort Break and Virtual Networking. By 11:45, I was learning about Pressure Ulcer Assessment, Reporting & Management. At 12:15, there was a presentation about Case studies in Small Breakout Groups. During the 12:35 session, I was Addressing Diversity in Pressure Ulcer Prevention.

    At midday by 13:00, I had a Lunch Break and Virtual Networking. Again, at 15:30, I had another Comfort Break and Virtual Networking. At 15:45, I learned about Nutritional Assessment and Pressure Ulcers. And to end the conference at 16:15, there were Question and answers. This included a survey to grade each session.

    During this conference, I also learned about Erythema and how it contributes to pressure ulcers. http://www.healthcareconferencesuk.com.

    Erythema

    Erythema is a type of skin rash caused by injured or inflamed blood capillaries. It usually occurs in response to a drug, disease or infection. Rash severity ranges from mild to life threatening. https://www.drugwatch.com/health/rash-and-skin-disorders/erythema/#:~:text=Erythema%20is%20a%20type%20of,from%20mild%20to%20life%20threatening.

    National Institute for Health and Care Excellence (NICE)- They provide national guidance and advice to improve health and social care. https://www.nice.org.uk/.

    National Wound Care Strategy Programme- The National Wound Care Strategy programme (NWCSP) seeks to improve care for people with wounds. http://www.nationalwoundcarestrategy.net.

    Model Health System- The Model Health System is a data-driven improvement tool that supports health and care systems to improve patient outcomes and population health. It provides benchmarked insights across the quality of care, productivity and organisational culture to identify opportunities for improvement. The Model Health System incorporates the Model Hospital, which provides hospital provider-level benchmarking. Access to the Model Health System is currently available for all NHS commissioners and providers in England. http://www.model.nhs.uk

    My Improvement Network are committed to investing in education for health care professionals and are proud supporters of RCN Projects. http://myimprovementnetwork.com.

    Pressure-Ulcer-March-2022Download

  • Pressure Ulcers, Transferring Equipment and Techniques

    Now that I’m a PURSUN Researcher, I’ve been studying pressure ulcers, prevention and cures. During my research, I’ve noticed we’ve discussed pressure points, mattresses, dieting, hygiene and PICOs, but nobody said anything about transferring techniques and equipment.

    Ever since my journey to fight against pressure ulcers has started, my transferring techniques have changed. While living in Bermuda, I was taught to ‘bum shuffle’ from, let’s say, my wheelchair to the bed or a chair. However, I was told that this is wrong. Climbing in and out of bed can also be risky, especially when barefoot. As a result, my transferring techniques have changed since then.

    Nowadays to prevent pressure ulcers, it has been suggested that I use a banana board or a sliding sheet from BACES in Bradford.

    The Bradford and Airedale Community Equipment Service (BACES) is a partnership between Bradford Social Services and the NHS in Bradford and Airedale.

    This service has been set up to provide you and your family with a wide range of equipment, to help you live more independently.

    Banana Transfer Board

    This Banana Transfer Board is designed to assist in the seated transfer of a patient between two surfaces.

    Transfers from Bed to wheelchair, wheelchair to Chair, wheelchair to toilet and the like, are just some of the uses the board can be put to. It was made from an extremely durable and hard-wearing materials, the transfer board is curved to facilitate positioning and features anti-slip pads on the underside for safer location and a convenient carrying handle. The board has a maximum user weight of 200 kgs (over 30 Stone) and can be easily cleaned with soapy water/alcohol/disinfectant and a non-abrasive cloth. I’ve tried this but it’s too hard on the buttocks and doesn’t help with shearing pressure.

    Hoists
    Hoists provide support for lifting and moving those in need from one place to another without causing undue stress or discomfort. They are used for moving from bed into a wheelchair, or vice versa, the range can carry a variety of weights and are good for the bathroom, bedroom, and all points in between. Part of the medical supplies and aids range, they also offer battery monitors, chargers, and slings for your hoist so you can be fully prepared to face the day. There are also travel cases available if you need to go somewhere and take your hoist with you, and specialist hoists for wet environments like the bathroom.

    Lateral Transfer Slide Board

    This is designed for use with the Transfer Glide Sheet, this Lateral Transfer Slide enables easy transfers between beds, trolleys, tables and treatment couches.

    It works by creating a stable, slip-resistant platform between the two points and by providing a smooth top surface over which the patient can easily be moved without the need for lifting. User comfort is enhanced by the slide’s tapered edges, which pass easily under the body, whilst the handles around the perimeter provide plenty of convenient places to grip and hold it steady. I’ve tried this but it’s risky and slightly flimsy.

    All our equipment is clean and maintained to the highest standards.

    What equipment do we offer?

    Equipment to help with:

    • moving, handling and walking 
    • bathing, showering and toileting 
    • household and kitchen tasks 
    • nursing tasks

    Commodes can also be used for pressure relief.

    Proper Transfer Techniques

    • The push-up – Use the wheelchair armrests (or wheels if you don’t have any) to push up out of the seat with your arms. You should straighten your arms fully so that your elbows are locked. Then ensure that the buttocks and lower back are fully out of the seat.
    • The forward lean – Lean forward as far as you can – imagine that you are trying to rest your chest on your knees! This movement is particularly good for relieving pressure on the coccyx.
    • Leaning side-to-side – Whilst seated, shift your body weight onto your left side to lift your right side out of your seat. Then repeat on the other side. Like the push-up, this movement relieves pressure from the buttocks and the lower back. However, because this is a more subtle movement it’s great to perform whilst you’re out and about!

    Why is proper transfer technique so important?

    Correct technique should minimise risk of skin injuries. Incorrect technique can increase your risk of falls during transfers. Managing the injuries which result from poor technique can be difficult and lengthy. Prevention is far superior to cure!

    https://www.bradford.gov.uk/adult-social-care/living-independently/bradford-and-airedale-community-equipment-service/

    https://www.completecareshop.co.uk/medical-supplies-aids

    https://www.yorkshirecareequipment.com/advice-tips/pressure-relief-techniques-for-wheelchair-users/

    Click to access the-role-of-the-physiotherapist-in-the-prevention-and-management-of-pressure-ulcer-cathy-quinn-201119.pdf

  • Stop the Pressure Campaign

    “Stop the Pressure” is an initiative from NHS Midlands and East, which has been rolled out across the NHS. The campaign used data collected by NHS Safety Thermometer and worked to raise awareness and improve monitoring and management of patients at risk of damage.

    They found that the number of new pressure ulcers was reduced by 50% in one year.

    A key part of the success of the campaign was attributed to a preventive strategy with a number of elements, referred to as the SSKIN bundle, which was communicated with great clarity.

    The acronym SSKIN contains five key steps:

    • Surface – make sure patients have the right support
    • Skin inspection – early inspection means early detection
    • Keep patients moving
    • Incontinence/moisture – patients need to be kept clean and dry
    • Nutrition/hydration – make sure patients have the right diet and plenty of fluids

    As part of a worldwide effort to reduce the prevalence of pressure damage, November 19th, 2020, saw the international Stop Pressure Ulcer Day. This year it will be celebrated on March 24, 2022, through a Virtual Conference.

    https://www.independentliving.co.uk/advice/prevent-pressure-ulcers/#stop

    www.healthcareconferencesuk.co.uk

    www.socialcareconferences.co.uk

    www.facebook.com/HealthcareConferencesUK

    https://www.healthcareconferencesuk.co.uk/conferences-masterclasses/pressure-ulcer-prevention

    Pressure-Ulcer-March-2022Download

  • Hygiene and Amputation

    With foot deformities and insensate feet, Spina Bifida patients are at risk of foot skin breakdown, pressure ulcers, and osteomyelitis. Rarely, pressure ulcers progress to squamous cell carcinoma. Spina Bifida patients may require limb amputation for osteomyelitis, foot ulcers, and squamous cell carcinoma. There is concern that transtibial amputations would have poor functional outcomes in Spina Bifida patients because of lower-extremity weakness.

    However, there is no available literature on transtibial amputation outcomes in this population. More distal calcanectomy and Symes amputations have been successful in restoring ambulation in lower-level Spina Bifida patients. https://journals.lww.com/ajpmr/Fulltext/2015/11000/From_Wheelchair_to_Cane__Elective_Transtibial.10.aspx

    Foot Care for Amputees

    LOOK
    Check your feet every day for any changes and use a hand mirror to see underneath your feet.


    PROTECT
    Wear correct fitting shoes and never go barefoot


    PREVENT
    Don’t allow problems to occur – wash and dry your feet properly every day.


    SEEK
    If you notice any changes immediately seek medical advice from a foot care professional


    DO
    Have an annual foot check from a podiatrist.

    For more information, you can search http://www.limbs4life.org.

  • Leg Elevation Rules

    Elevating legs occasionally

    Rest– Immediately rest the affected area as much as possible. Experts recommend 24 to 48 hours of no weight-bearing activities. Continued use of a moderate or severely sprained ankle can delay healing, increase pain, or even worsen the injury. With a mild sprain, activity is generally tolerated after 24 to 48 hours of rest.
    Ice– To help reduce pain and swelling during the first 48 hours after injury, ice the area 20 minutes at a time every 4 hours, using an ice pack covered in a towel. If you don’t have an ice pack handy, an alternative would be to use a bag of frozen peas, corn, or other veggies. Try not to ice the injury for more than 20 minutes at a time, as it may actually cause further tissue damage.

    In the majority of studies, researchers found icing was effective in numbing muscle soreness, but observed — for up to 15 minutes after ice treatment — significantly reduced:

    • Muscle strength
    • Power
    • Fine motor coordination


    Compression– Using an elastic medical bandage, wrap the area to help decrease swelling and internal bleeding (if present). The wrap should be snug, but make sure you have proper circulation. Some signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling. If you think you need to use the wrap for more than 48 to 72 hours, you may have a more serious issue that requires prompt medical attention.


    Elevating your limbs and Exercise! Raise the injured body part above heart level so that gravity can move fluids away from the injured area.

  • The frequency of lymphoedema in an adult Spina Bifida population

    The Fight Against Pressure Ulcers

    Lymphoedema


    Lymphoedema is a swelling often of your legs which is due to fluid collecting in the tissues under the skin. This can leave you prone to cellulitis and skin breakdown, and can interfere with independence as your legs get heavy and difficult to move. Ask your GP to arrange treatment with pressure stockings or appliances, which are very effective.

    The National Lymphedema Network (lymphnet.org) defines lymphedema as “an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arms and/or legs, and occasionally in other parts of the body. Lymphedema can develop when lymphatic vessels are missing or impaired or when lymph vessels are damaged or lymph nodes removed.

    Feet
    It is suggested that you see a podiatrist/chiropodist regularly to have your toenails cut and hard skin removed if you have loss of feeling or poor circulation in your feet. Use a foot-softening cream on your feet and moisturiser on your legs to prevent cracking as bacteria can enter this way. If your skin is very dry, use aqueous cream instead of soap when bathing. Dry carefully between your toes and treat athlete’s foot straight away. Creams and sprays are available from pharmacies and larger supermarkets.

    There have been very few studies to date documenting the occurrence of lymphedema in the Spina Bifida population, despite a case series in 2001 that suggested that the occurrence may be higher than in the general population. A total of 240 electronic medical records from the Adult Spina Bifida Clinic from January 2005 to August 2008 were retrospectively reviewed.

    This is why incontinence/ moisture management, movement, and sensation are important for Spina Bifida patients.

    10 Methods to tackle swollen feet

    1. Drink 8 to 10 glasses of water per day
      Though it might seem counterintuitive, getting enough fluids actually helps reduce swelling. When your body isn’t hydrated enough, it holds onto the fluid it does have. This contributes to swelling.
    2. Buy compression socks
      Compression socks can be found at a drug or grocery store or even bought online. Start with compression socks that are between 12 to 15 mm or 15 to 20 mm of mercury.

    They come in a variety of weights and compressions, so it might be best to start off with lighter-weight socks and then find the kind that provides the most relief.

    1. Soak in a cool Epsom salt bath for about 15 to 20 minutes
      Epsom salt (magnesium sulfate) may not only help with muscle pain. It may also reduce swelling and inflammation. The theory is that Epsom salt draws out toxins and increases relaxation.

    Just make sure to get Epsom salts marked with the USP designation. This means that it meets standards set forth by the U.S. Food and Drug Administration and is safe to use.

    1. Elevate your feet, preferably above your heart
      Prop your feet on cushions, pillows, or even things like phone books, when you sleep. If you’re looking to reduce foot swelling while pregnant, try elevating your feet several times a day as well. Aim for about 20 minutes at a time, even on an ottoman or a chair.

    Try to avoid standing for long periods of time and stay off your feet when you can.

    1. Get moving!
      If you sit or stand in one area for a long period of time (like at work), this can lead to swollen feet. Try to move a little bit each hour, even if it’s a walk to the break room, a walk around the block at lunch, flexing your knees and ankles, or a lap around the office.
    2. Magnesium supplements can be helpful for some people
      If you retain water, you might have a magnesium deficiency. Eating foods high in magnesium can help. Magnesium-rich foods. Trusted Source to add to your diet include:
    • almonds
    • tofu
    • cashews
    • spinach
    • dark chocolate
    • broccoli
    • avocados
    • Taking 200 to 400 milligrams of magnesium daily might help with the swelling. But before you take any kind of supplement, ask your doctor. Magnesium supplements aren’t right for everyone, especially if you have a kidney or heart condition.
    1. Make some dietary changes
      Reducing your sodium intake can help decrease swelling in your body, including in your feet. Opt for low-sodium versions of your favourite foods, and try to refrain from adding salt to meals.
    2. Lose weight if you’re overweight
      Being overweight can cause reduced blood circulation, leading to swelling of the lower extremities. It can also lead to extra strain on the feet, causing pain when walking. This can result in being more sedentary — which can also cause fluid buildup in the feet.

    Losing weight can help ease the strain on your feet and possibly reduce foot swelling as well. Talk with your doctor about whether you need to lose weight and healthy ways to go about doing so.

    1. Massage your feet
      Massage can be great for swollen feet and can also promote relaxation. Massage (or have someone massage them for you!) your feet toward your heart with firm strokes and some pressure. This can help move the fluid out of the area and reduce swelling.
    2. Increase your intake of potassium-rich foods
      A potassium deficiency can contribute to high blood pressure and water retention. If you have no dietary restrictions, consider eating foods containing potassium. Some potassium-rich foods. Trusted Source include:
    • sweet potatoes
    • white beans
    • bananas
    • salmon
    • pistachios
    • chicken
    • Try drinking orange juice or low-fat milk instead of soda, too. If you have any medical conditions, especially kidney issues, talk with your doctor before adding lots of potassium to your diet.

    How long should I elevate my feet to reduce swelling?


    The more the swelling and the longer there has been swelling, the longer and more frequently your need to elevate your legs. Start with 20 minutes twice a day. This might do the trick. If not, go to 30 minutes or even an hour.

    LET’S WORK TOGETHER TO STOP THE PRESSURE!!!

    https://www.shinecharity.org.uk/self-care/skin-and-tissue

    https://mobilitymgmt.com/Articles/2011/06/01/Lymphedema.aspx

  • PICOs and Pressure Ulcers

    Technology

    PICO is a canister-free, single-use, negative pressure wound therapy system consisting of a sterile pump and multi-layered adhesive dressings. Each dressing has 4 layers: a silicone adhesive wound contact layer, which is designed to minimise pain and damage during peel-back and to reduce lateral tension; an airlock layer for even distribution of pressure; an absorbent layer to remove exudate and bacteria from the wound; and a top film layer, which acts as a physical barrier and allows moisture to evaporate. The pump is operated by 2 AA batteries and delivers a continuous negative pressure of 80 mmHg to a sealed wound. Once activated, using a push button, the battery drives the pump for up to 7 days and LEDs provide alerts for low-battery status and pressure leaks.

    Standard PICO dressings come in 8 sizes: 10×20 cm, 10×30 cm, 10×40 cm, 15×15 cm, 15×20 cm, 15×30 cm, 20×20 cm and 25×25 cm. Multisite PICO dressings come in 2 sizes: small (15×20 cm) and large (20×25 cm).

    The latest version of the technology is the PICO7 system. This differs from the version of PICO notified to NICE by having an improved pump to minimise leakage and an integrated belt clip to allow for easier transport. The PICO7 pump contains a magnet and it should be positioned at least 10 cm (4 inches) away from other medical devices that could be affected by magnetic interference.

    Innovative aspects

    PICO differs from conventional negative pressure wound dressings in that it:

    • has no separate canister
    • is portable and disposable
    • has a proprietary dressing layer that is designed to allow even distribution of negative pressure across the incision and zone of injury.

    The Purpose behind the PICO

    PICO is intended for surgical incisions with low or moderate levels of exudate. This guidance focuses on the use of PICO dressings for closed surgical incisions. PICO dressings can be applied by healthcare professionals including surgeons and tissue viability nurses for people in a range of care settings. Training is needed to place the dressings correctly. My District Nurses are the only ones that can dress, undress and re-dress my wounds.

    Costs

    Standard PICO dressings are available in 8 different sizes. Each pack includes a single-use pump and 2 dressings. The list prices for PICO dressings range from £127.06 to £145.68 (including VAT).
    https://www.smith-nephew.com/key-products/advanced-wound-management/pico/.

    LET’S WORK TOGETHER TO STOP THE PRESSURE!!!

  • The Fight Against Pressure Ulcers!!!

    MORE TIPS

    Skin Checks
    Surfaces- Beware of pressure on pelvic bones depending on how you sit.
    Keep Moving
    Increased Moisture Management because increased moisture could imply or result in heart failure.
    Nutrition

    STOP THE PRESSURE!!!

    http://www.legsmatter.org.

  • Dietary Impact of Food on Pressure Ulcers

    Pressure ulcers (also known as pressure sores) occur when the skin and surrounding tissue is damaged by medical devices or the weight of the body pressing down. This restricts blood flow and the delivery of oxygen and nutrients to the area. They often develop where bones are close to the skin such as on the lower back/spine, hips, heels and elbows. Having a poor nutrient and fluid intake can increase the risk of pressure ulcers.

    The risk increases in those who are underweight or overweight. Maintaining a healthy weight and eating a balanced diet can reduce the risk of developing pressure ulcers. You should try to adopt a meal plan like this:

    Breakfast
    Mid-morning snack
    Lunch
    Mid-afternoon snack
    Dinner
    dessert

    This is because being overweight can reduce mobility and increase the weight bearing load through pressure areas such as the bottom.
    Being underweight can mean there is less natural padding on bony areas such as the bottom and hips.
    The skin needs a good supply of fluid and nutrients to maintain its circulation and keep it supple.


    Nutrition and pressure damage
    Once a pressure ulcer has developed, nutrition plays a vital role in the healing process. This is because the body needs protein, energy (calories), vitamins and minerals (such as vitamin C, iron and zinc), and plenty of fluids to support the wound healing process.

    Protein
    Your body may need more protein if you have a pressure ulcer. Foods that are high in protein include meat, fish, eggs, dairy products, nuts, beans and pulses. Try to have at least one of these foods at each meal. Aim to have one pint of milk per day or a variety of milk and dairy foods such as milk puddings, cheese or yoghurts.

    If you are overweight choose low fat versions. They contain the same amount of protein as full fat versions but are lower in calories. There are also some yoghurts, ice cream and milks available that contain higher amounts of protein.

    If you use milk substitutes, soya milk contains a similar amount of protein as cow’s milk. Oat, rice, hemp and nut based milks contain significantly less protein.

    Iron
    Iron is important for the healing process by helping to maintain adequate blood haemoglobin levels. Foods that are good sources of iron include meat, fish and eggs. Iron is also found in other food such as beans, pulses, green vegetables and dried fruit, but these are less easily absorbed.

    Vitamin C
    Vitamin C helps with the absorption of iron from your food and also directly with the healing process. Vitamin C is found in a wide variety of fruit and vegetables. It is not stored in the body so a daily supply is needed. Vitamin C is destroyed during the cooking process, so it is important not to overcook your vegetables, or if possible, steam them. Drinking a small glass of fruit juice (150ml) with your meal is a good way to improve your intake. If your vitamin C intake remains low you may need to take a supplement.

    Zinc
    Zinc is important for the formation of new skin tissue and to help pressure ulcers to heal. Good sources are lean red meat, shell fish, milk, cheese, bread, lentils, beans and cereal products such as wheatgerm.

    Vitamin and mineral supplements
    If you cannot eat enough foods containing key vitamins and minerals then you may need to take a supplement. If you are unable to manage a varied diet, or have a poor appetite, an “A to Z” type vitamin and mineral supplement may be necessary and these are available from many high street chemists. If you are managing to eat a full and varied diet then there is no benefit in taking high levels of vitamins and mineral supplements – in fact, this can be harmful.

    Fluid
    Dehydrated skin can become dry and fragile. It is important that your skin is kept moist from the inside. You should aim for 1.5 to two litres per day (six to ten mugs). This could include any liquid (tea, coffee, milk, water, juice) but not alcohol. If you are overweight avoid drinks that contain sugar, choosing sugar free alternatives or using low-calorie sweeteners in hot drinks.

    Body weight
    If you are overweight, losing weight could help to reduce the risk of pressure ulcers and protect a newly healed pressure ulcer. However, if you restrict your intake too much whilst a pressure ulcer is healing it could delay the healing process.

    It is important that you maintain a balance to your diet so that your body continues to get all the nutrients it needs. Simple changes that you could make to your diet if you are overweight are:

    • Cutting out sugar from hot drinks or using a sweetener.
    • Using low fat cooking methods such as grilling, baking, microwaving or steaming rather than frying.
    • Opting for snacks that are lower in energy and fat such as low fat yoghurts and fruit.
    • Remember to have meals that are balanced. Try not to miss meals.
    • Aim to lose an average of no more than 0.5 to 1kg a week.


    If you are underweight, pressure ulcers need a lot of nutrients to help them heal. If you are underweight you may not have enough nutrient stores in your body so you will need extra nutrition from your diet. Without nutrients the healing process may take longer. Some changes that could help to increase your intake are:

    Ensure that you have regular meals. If you find it difficult to prepare and cook meals then there are a wide variety of tinned, chilled or frozen ‘ready meals’ available. Frozen or tinned vegetables can also be useful.
    Try to have three small meals and two to three nourishing snacks throughout the day (such as yoghurts, cheese, nuts and biscuits).
    If your appetite is poor, try to also include two nourishing drinks each day such as: milk, malted milk drinks, fruit juice or powdered supplement drinks which are available from your local chemist or supermarket.
    Oral Nutritional Supplements (sip feeds)
    If your food intake remains low, it may not be enough to help heal the pressure ulcer. If this is the case, it may be necessary for you to have some prescribed oral nutritional supplements. These types of drinks provide a rich source of energy, protein and other nutrients. A dietitian may be available to discuss with you the most appropriate one and how many you will need. You should not take additional vitamins and mineral supplements if you are taking three or more oral nutritional supplements per day.

    If you have diabetes, poorly controlled diabetes can delay healing. Diet and medication may need to be adjusted to achieve good diabetic control. Speak to your GP, nurse or dietitian if you require help with this.

    Eating a balanced diet and having a healthy body weight will help to reduce the risk of developing a pressure ulcer. If you have a pressure ulcer, eating and drinking well will help it to heal. If you are overweight then it would be beneficial to try to lose weight gradually. If you are underweight then weight gain will help improve the padding over the bones. This can be best achieved by eating small and frequent meals and snacks.

    For more information, you can follow: https://www.bda.uk.com/resource/pressure-ulcers-pressure-sores-diet.html.