Daily Routines for Preventing Pressure Sores in Bed

Why a Daily Routine Matters More Than Any Single Product

Pressure sores — also called pressure ulcers or bed sores — develop when sustained pressure reduces blood flow to the skin and the tissue beneath it. For someone spending most of the day and night in bed, that pressure builds up quietly, usually over the bony points: the base of the spine (sacrum), heels, hips, elbows, shoulder blades, ears and the back of the head. Damage can begin within a few hours and may start under the surface before anything is visible on the skin.

That is why prevention is never about one piece of equipment. It is about a repeating pattern of small actions across the day — the kind of routine that fits around meals, medication and rest, and that family carers can share between them. The NHS uses the SSKIN checklist as a memory aid: Surface, Skin inspection, Keep moving, Incontinence, Nutrition. Keep those five in mind as you build your own schedule.

Start the Day with a Full Skin Inspection

Morning is the easiest time to look properly, especially when helping someone wash or dress. Work in good light and check every pressure point in the same order each day, so nothing gets missed.

• Look at the sacrum and buttocks first, then heels, ankles, hips, elbows, shoulders, ears and the back of the head.
• A red patch on pale skin is not always a concern, but a red patch that does not fade when you press it with a finger for a few seconds needs reporting the same day.
• On darker skin, redness is harder to spot. Look instead for areas that are darker, purple, blue or shiny, or that feel warmer, firmer or spongier than the skin around them.
• Check for blistering, cracked skin, or any patch that looks like a bruise when there has been no knock or fall.

Make a note of anything new and exactly where it is, so you can describe it clearly to a district nurse or GP. Photographs taken in consistent light can help show whether something is changing.

Build a Turning and Repositioning Pattern

The old advice was to turn someone every two hours around the clock. Current guidance is more personal: the right frequency depends on the person's skin, their mattress or overlay, their weight, and how well they can shift themselves. For most people at higher risk, two to four hours is a sensible starting point, agreed with their nurse.

Techniques that make a real difference:

• Tilt to about 30 degrees rather than lying flat on the back or fully on the side. Pillows or a wedge behind the back hold the position.
• Use a slide sheet or hoist rather than dragging. Friction and shearing strain the skin as much as pressure does.
• Keep heels off the mattress with a pillow under the calves so they hang free — heel ulcers are among the most common and most preventable.
• Place a pillow between the knees so bony points are not pressing together.
• Raise the head of the bed only as much as needed for eating or breathing, then lower it again. Sliding down the bed causes shearing.

If the person can help at all, encourage small shifts — bending a knee, pressing a heel down, lifting the hips for a few seconds. Even a little movement gives the skin valuable recovery time.

Keep Fluids, Food and Continence in the Picture

Well-hydrated, well-nourished skin tolerates pressure far better. Offer a drink every time you do a turn, and keep a jug within easy reach. Food matters too: protein, vitamin C and zinc support skin repair, so a fortified soup, eggs, cheese, yoghurt or a milky drink can be more useful than a large plain meal when appetite is poor.

Wet or soiled skin breaks down quickly. Check and change pads frequently, clean gently with warm water and a mild cleanser, and pat rather than rub. A barrier cream on intact skin helps protect against moisture. If continence is becoming harder to manage, ask for a continence review — it is a clinical issue, not a failure of care.

Evening Checks: Equipment, Cushions and Bedding

Before settling someone for the night, take two minutes to check the things that keep pressure low.

• Run a hand over the mattress or overlay for creases, crumbs, rucks or a deflated section. A crease under a heel can do real damage overnight.
• Confirm that any alternating-pressure mattress or cushion is switched on and working, and that the pump setting matches the person's weight.
• If they sit out in a chair during the day, check the cushion for wear and flatness — foam compresses over time and stops doing its job.
• Smooth the bottom sheet, choose nightwear without thick seams or buttons, and clear the bed of anything that could press into the skin.

When to Ask for Help, and How to Share the Load

Contact a district nurse, GP or tissue viability service promptly if you notice broken skin, a blister, a red patch that does not fade, a purple or black area, unusual warmth, swelling, or any discharge or odour. Early pressure damage is far easier to treat than a deep ulcer, and a delay of a day or two can genuinely matter.

Finally, no single carer can keep this up alone. Write your turning times on a chart by the bed, include the skin check and the drink offers, and let everyone — family, paid carers, nursing staff — tick off each step as they go. A routine that is shared is a routine that actually happens, and that consistency is what protects skin.