Existing pressure damage, role boundaries and escalation

When a resident already has pressure damage, carers still play an important role, but it is a role with boundaries. NHS England's care-home framework says care home staff should ensure residents receive appropriate individualised wound care with referral to the local wound-care service, and that staff are supported to implement the care plan recommended by that service. That means carers should follow the plan, protect the resident's comfort and escalate changes promptly.

In many homes, diagnosing, grading or changing the wound-treatment plan sits with nurses or external clinical teams, not with general care staff. Frontline carers should not casually label a wound, apply unplanned products or make up a new treatment routine because it seems quicker. They should describe exactly what they can see, say what has changed, and use the agreed escalation route.

Sensitive image Clinical image showing pressure wound stages. Click to reveal. Click to reveal

Signs that need prompt escalation

• New skin break: especially over a pressure area.
• Worsening pain or discolouration: even if the skin is still intact.
• Redness, heat, smell or leakage: these may suggest worsening damage or infection.
• Unclear discharge information: staff should not guess the wound plan after hospital discharge.
• Plan failure: if the resident cannot tolerate the plan or the skin is worsening, say so.

Manager focus: referral routes and competence

Sensitive image Clinical photograph of pressure damage. Click to reveal. Click to reveal

Clear role boundaries are part of safe care. Carers protect residents by escalating well, not by guessing beyond their competence.