Intended for healthcare professionals

Practice Guidelines

Prevention and management of pressure ulcers in primary and secondary care: summary of NICE guidance

BMJ 2014; 348 doi: (Published 23 April 2014) Cite this as: BMJ 2014;348:g2592
  1. Gerry Stansby, professor of vascular surgery and honorary consultant vascular surgeon1,
  2. Liz Avital, associate director2,
  3. Katie Jones, project manager2,
  4. Grace Marsden, senior health economist2
  5. On behalf of the Guideline Development Group
  1. 1Department of Vascular Surgery, Freeman Hospital, Newcastle upon Tyne, UK
  2. 2National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  1. Correspondence to: L Avital liz.avital{at}

Pressure ulcers are serious and distressing, and they can affect people of any age. Not only do they increase mortality, result in extended hospital stays, and consume substantial healthcare resources, they are often an example of avoidable harm. Reported prevalence rates range from 4.7% to 32.1% in hospital populations and as much as 22% in nursing home populations.1 Prevention of this devastating condition must be a priority for the NHS. Stage 1 pressure ulcers (see box for definition of stages) can be reversible if identified promptly, and most stage 2 and 3 ulcers can be healed with appropriate care, but all require a multidisciplinary approach for effective management. It is hoped that this guideline will help reduce pressure ulcers nationally and improve care when pressure ulcers do occur.

Pressure ulcer categories/stages2

Category/stage 1: Non-blanchable redness of intact skin

Intact skin with non-blanchable erythema of a localised area, usually over a bony prominence. Discoloration of the skin, warmth, oedema, hardness, or pain may also be present. Darkly pigmented skin may not have visible blanching.

The area may be painful, firm, soft, and warmer or cooler than adjacent tissue. This category may be difficult to detect in people with dark skin tones. It may indicate that the person is “at risk.”

Category/stage 2: Partial thickness skin loss or blister

Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. May also present as an intact or open (or ruptured) blister filled with serum or sero-sanguinous fluid.

Presents as a shiny or dry shallow ulcer without slough or bruising. This category should not be used to describe skin tears, tape burns, incontinence associated dermatitis, maceration, or excoriation.

Category/stage 3: Full thickness skin loss (fat visible)

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle is not exposed. Some slough may be present, as may undermining, where the ulcer extends under the surface.

The depth of …

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