Who may be at higher risk and why carers matter

Some residents are at higher risk because they cannot move easily, cannot reposition themselves, have had pressure damage before, are eating or drinking poorly, are more sleepy after illness, or have become weaker after a hospital stay. Others may look settled, but are actually spending much longer in bed or in a chair than usual, which can quietly raise risk over several shifts.

NICE quality standards also treat adults with a history of pressure ulcers, or a current pressure ulcer, as high risk. That means staff should not assume an old problem is finished just because the skin looks better today. Previous damage is a warning that the person's skin may break down again unless the prevention plan still fits.

Residents who may need extra attention

• People with limited mobility: especially those who stay in bed or a chair for long periods.
• People who need help to reposition: they may not be able to relieve pressure themselves.
• People with previous pressure damage: healed skin may still be vulnerable.
• People with poor intake or weight loss: skin and healing may be affected.
• People who are unwell, frail or newly confused: illness can change movement, continence and tolerance of care.
• People after discharge or deterioration: the old care plan may no longer match current needs.

Manager focus: risk tools and role boundaries

Risk is not only about who is bedbound. It is also about who has quietly become less able to protect their own skin.