“Pressure injury” is a more accurate label than “pressure ulcer” as some pressure injuries are not open wounds. However, injury can be misconstrued as someone having caused that injury and that is not usually the case.
The European Pressure Ulcer Advisory Panel recommended using the word ‘Category’ rather than ‘Grade’. However, it matters very little which terminology is used as long as it is consistently used.
Blanching erythema redness (FIG. 1)
In the paler skin, the redness can be quite clearly seen. It is where the blood has not been able to reach the area under pressure. If we were to look at the area of pressure through glass, it would be white and, when repositioned, the body would immediately compensate for the lack of blood and send in more blood than required, flushing it bright red. This should fade within 20 minutes.
If Healthcare Assistants are taught to examine the pressure areas of vulnerable people and to report if the redness they find does not go within 20 minutes, then we can be proactive in prevention of pressure ulcers by either placing on appropriate equipment and/or increasing repositioning.
If a finger is pressed in the centre of this redness, then it will again exclude the blood turning the area white. This should immediately reflush. This means there is no damage to the area but the redness acts as a warning.
Blanching erythema in the darker skin (FIG. 2)
The darker skin will not flush red but will become darker over the area of pressure. Increased vigilance is required for the darker skin as it is not so easy to identify the warning signs (Fig 17). The darker skin will not flush red but will become darker over the area of pressure.
Increased vigilance is vital in such an instance. Reassess pressure ulcer risk if there is a change in clinical status such as a worsening of an underlying condition or with a change in mobility.