Feeding the skin

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Skin is just like a plant: without food and water the leaves will wither and break. Here, CQC specialist adviser in tissue viability Siobhan Mccoulough explains how to prevent pressure ulcers through good diet and hydration 


Providing residents with adequate nutrition and hydration is a vital component for pressure ulcer prevention and treatment. The skin is a living, functioning and complex organ, which requires feeding and hydration to function. Vital nutrients help the skin repair and regenerate. 

Old age, pressure ulcers and malnutrition may co-exist. Wounds in older people may already be slow to heal as a result of compromised skin integrity, which occurs as part of the normal ageing process. Malnutrition is also more common in older people, and evidence has shown that inadequate nutrition may lead to impaired and prolonged wound healing. 


When an inspector calls 

CQC inspectors will look for evidence of regular nutritional screening assessments to demonstrate care planning for pressure care prevention. Where care homes have excelled in their nutrition and hydration, there is evidence of nutritional assessment and reassessment, and individual care planning. There should also be a tissue viability or nutrition champion in-house and a clearly-documented and actioned escalation process for concerns. 

The hallmarks of poor care in nutrition, which often leads to serous pressure ulcers, include broken weighing equipment, staff unable to perform other benchmark tests such as the ulna measurement check, lack of assistance at lunch times, and low mood of the residents resulting in poor appetite. 

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The basic building blocks of the skin 

The skin is made up of only three layers - the outer layer is the epidermis, the second, an inner layer of soft tissue called the dermis, and a base layer called the subcutis or subcutaneous. The base layer includes a seam of fat that the body uses as a fuel reserve in case of food shortage; this also works as insulation. 

The epidermis layer is constantly growing and repairing itself. New skin cells regenerate on a daily basis, replacing dead skin cells which are shed. 


Nutrition for skin function

As an organ of the human body, skin naturally reflects your body’s internal needs, including the nutrients it requires. Changes in the skin can be a valuable visual clue that there is suboptimal nutrition or something else going on internally. The care giver who sees a resident daily is the key person to identify any changes taking place. 

There is no single magic diet to prevent pressure ulcers; the best approach is to offer a balanced diet and the plate model, as advocated by the Food Standards Agency in 2002, provides a useful visual template. 

However, residents with compromised nutrition must be supported with an individualised food and fluid care plan, with expert advice from a dietician and speech and language therapists. Those with a low risk score may be adequately supported by a balanced general diet, with regular weight checks. Changes to the skin, or even just a ‘less healthy look’, even if weight is unchanged, should be reported to the patient’s GP or the home’s senior nurse as it may be an indicator of something else going on internally. A pressure ulcer is often a first sign that there is nutritional compromise, internal changes, or external pressure forces. 

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Testing for a grade 1 non-blanching erythema. If the area remains red after applying pressure for three seconds, change the resident’s position to relieve pressure on the affected area and alert somebody immediately, so that all risk assessments including the MUST nutritional assessment can be reviewed 


How secure is your home. (2018). Care Home management, (75), p.33.

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