Pressure-injury prevention at home begins with assessment. The person’s risk, skin, mobility, sensation, nutrition, continence, equipment, comfort and preferences should produce an individual care plan with a documented repositioning schedule and escalation route.
A family or caregiver can carry out agreed prevention, observation and records. They should not invent a turning interval, support surface, wound dressing or nutrition treatment from a general article.
Ask for an assessed prevention plan
NICE recommends documented risk assessment when relevant risk factors are present, such as limited mobility, loss of sensation, previous pressure injury, nutritional deficiency, inability to reposition or significant cognitive impairment. Risk should be reassessed after a clinical or mobility change.
Before discharge or when home risk becomes apparent, ask the responsible nurse, doctor or pressure-care team to document:
- current risk and skin assessment;
- areas requiring particular pressure relief;
- repositioning frequency and permitted positions;
- how much the person can reposition independently;
- approved moving method and equipment;
- mattress, cushion and heel strategy;
- continence and moisture plan;
- nutrition or hydration referral where needed;
- skin observations and recording method;
- which change requires same-day or urgent contact; and
- who reviews the plan.
The plan should account for the person’s wishes, pain, sleep and clinical conditions rather than treating them as a body to turn on a timer.
Do not substitute a universal timetable
A fixed “every two hours” rule is not suitable for every person, surface or level of risk. NICE uses minimum reference intervals for adults assessed at risk or high risk while also requiring the frequency to be documented and individualised. The 2025 International Guideline likewise treats repositioning as part of a broader personalised prevention strategy.
Follow the written schedule. If the person develops new pain, persistent skin change or cannot tolerate an assigned position, contact the responsible professional rather than silently extending or shortening the interval.
Record each assisted repositioning and any declined or incomplete attempt. Include the position, time, reason and action taken.
Use the approved moving method
Dragging a person across a sheet or lifting without adequate help can injure the person and caregiver. Ask the treating physiotherapist, occupational therapist, nurse or moving-and-handling professional to demonstrate the method and equipment for this person.
The plan may specify:
- independent weight shifts;
- assisted rolling;
- slide sheets or another moving aid;
- bed functions;
- number of helpers;
- sitting duration;
- transfer method; and
- positions to avoid because of pain, surgery, breathing or another condition.
Do not copy a thirty-degree tilt, heel setup or chair technique from an article unless it appears in the person’s plan. A position that protects one area may load another or conflict with a clinical restriction.
Observe skin under good conditions
A trained healthcare professional should perform the clinical skin assessment for someone at high risk. The home plan may also ask family or caregivers to make routine observations during agreed care.
Check only to the extent the person consents and the role requires. Compare pressure areas for:
- intact versus broken skin;
- colour change or discolouration;
- redness that does not blanch when assessed by someone trained to do so;
- unusual heat or coolness;
- firmness, softness or bogginess;
- moisture;
- swelling;
- pain or tenderness;
- blistering; and
- dark or purple areas.
On darker skin, colour change may be less visible. Temperature, texture and pain can therefore be important observations. Do not press, massage or rub a suspicious area; NICE advises against massage or rubbing to prevent pressure injury.
Record the site, time, appearance, discomfort and action. Do not diagnose the stage or depth unless qualified and authorised to assess it.
Escalate before skin breaks
Persistent non-blanching redness or discolouration requires preventative action and professional review under the plan. Broken skin is not the only point at which help is needed.
Contact the named service promptly after:
- persistent pressure-area colour change;
- new heat, firmness, bogginess or pain;
- blister, dark tissue or broken skin;
- drainage, odour or rapidly changing wound;
- fever or systemic illness;
- inability to follow the repositioning plan;
- equipment failure; or
- a major mobility or health change.
Call 999 for an immediately life-threatening emergency. The treating team should specify the urgent route for a pressure-injury concern outside normal hours.
Match the support surface to the assessed need
NICE recommends pressure-redistributing mattresses and cushions for defined risk situations. Selection should consider risk, body size, mobility, posture, transfers, heat, moisture, equipment compatibility and the person’s comfort.
Ask the professional or supplier acting under the plan:
- exact product and settings;
- whether a powered surface needs backup after electricity failure;
- how to check correct operation;
- cleaning and maintenance;
- safe transfer and bed-rail interaction;
- replacement or rental support; and
- whether repositioning remains required.
A pressure-redistributing surface does not automatically remove the need to reposition. Do not use a ring or improvised cushion unless specifically prescribed for another purpose after appropriate assessment.
Protect heels according to the plan
NICE recommends an individual heel-offloading strategy for someone at high risk of heel pressure injury. Do not assume that placing a pillow anywhere under the legs is safe or sufficient.
The plan should state:
- whether heels need full offloading;
- the approved device or pillow placement;
- alignment and skin checks;
- interaction with contractures, pain or circulation problems;
- when the setup is removed; and
- what to do if it slips or causes pressure elsewhere.
A caregiver should report a heel resting on the surface when the plan requires offloading rather than redesigning the setup independently.
Manage moisture without damaging skin
Urine, stool, sweat, wound drainage and excessive dryness can increase skin vulnerability. Follow the continence and skin-care plan.
It may include:
- prompt but unhurried cleansing;
- a gentle product;
- careful drying without friction;
- a barrier preparation where advised;
- suitable continence products and change schedule;
- breathable bedding and clothing; and
- reporting leakage, diarrhoea or skin inflammation.
Do not scrub, use harsh antiseptics or apply several creams without knowing how they interact with the skin plan or continence product.
The guide to managing incontinence with dignity covers privacy and practical handover.
Address nutrition and hydration through assessment
Nutritional deficiency is a pressure-injury risk factor, but supplements should not be started automatically. NICE advises nutritional assessment for adults with a pressure ulcer and supplements when a deficiency is identified, not simply for everyone with adequate intake.
Record persistent poor intake, swallowing difficulty, unplanned weight change or a prescribed fluid issue and contact the treating team. Ask for a dietitian, pharmacist or swallowing assessment where indicated.
A caregiver follows the current food and fluid plan and reports difficulty. They should not prescribe protein products, fluid targets or dietary restrictions.
Keep one pressure-care record
The active record should show:
- assessed risk and review date;
- repositioning schedule;
- position and time completed;
- skin observations;
- equipment checks;
- continence or moisture issues relevant to the plan;
- refusal, pain or inability to complete care;
- clinical contact and advice; and
- changes made by the authorised professional.
Use one controlled version across family and paid caregivers. A verbal message in a group chat should not replace the professional plan.
Define caregiver scope
A caregiver may be authorised and trained to assist with repositioning, skin observation, continence care, equipment checks and records. A nurse or other qualified professional assesses a suspected pressure injury and sets wound treatment.
A dressing may later be delegated or assigned only where the task, worker, training, hiring-household or care-service policy and written plan permit it. The caregiver must not choose a dressing, debride tissue, stage a wound, start an antibiotic or change treatment independently.
The caregiver and nurse roles guide helps the family document that boundary.
Review after every change
Request reassessment after:
- hospital admission or discharge;
- surgery;
- a fall;
- reduced mobility or sensation;
- new incontinence or diarrhoea;
- poor intake or weight loss;
- equipment change or failure;
- pain that limits repositioning;
- new pressure-area skin change; or
- a caregiver reporting that the current plan cannot be completed safely.
Pressure-injury prevention is not a generic turning routine. It is a documented individual plan, suitable equipment, trained assistance, respectful observation and timely clinical response when the skin or person’s condition changes.