Pressure Injury Prevention at Home & in Facilities

Why prevention comes first

Pressure injury prevention at home and in facilities starts with one idea: skin that is pressed between a bone and a surface for too long is starved of blood flow. Rubbing, sliding down in bed and moisture add to the damage. An injury can begin under skin that still looks intact.

The treating clinician reviews risk and writes the plan. Gateway arranges the visits with partner clinicians across Greater St. Louis and the Metro East, and coordinates the equipment, communication and follow-up that put the plan into daily use.

Who is at higher risk

Risk rises when a person cannot easily shift their own weight. The clinician pays close attention to people who:

Spend most of the day in a bed, recliner or wheelchair
Have reduced feeling from diabetes, stroke or spinal injury
Have incontinence or skin that stays damp
Are eating or drinking poorly, or have lost weight
Have dementia and cannot say when something hurts
Have just come home from a hospital stay or surgery
Have had a pressure injury before

What a risk review looks at

A risk review is a head-to-toe look at skin plus a set of questions about daily life. The clinician checks bony areas such as the tailbone, hips, heels, ankles, elbows, shoulder blades and the back of the head. Skin under oxygen tubing, braces and other devices is checked too.

Facilities often use a standard scoring tool to rate risk. At home, the clinician asks similar questions about movement, moisture, nutrition and who is available to help.

Repositioning and movement

Changing position moves pressure from one area to another and lets blood return. How often depends on the person, the surface they are on and how their skin responds. The treating clinician sets the schedule, and it may be different for bed and chair.

How a person is moved matters as well, because dragging skin across sheets can injure it. Caregivers can find safe techniques in our guide to lifting and turning safely, and a sample routine in the repositioning schedule at home guide.

Support surfaces and cushions

A support surface is a mattress, overlay or seat cushion designed to spread weight more evenly. The clinician decides whether one is needed and which type suits the person’s risk, size and movement.

No surface replaces repositioning. Ring-shaped or donut cushions are generally not recommended, so ask the clinician before buying one. Our guide to cushions and mattresses for pressure relief explains the main options. When the clinician orders equipment, Gateway helps get the order to a supplier.

Skin checks and moisture care

Daily skin checks catch problems while they are still small. On lighter skin, an early sign is redness that does not fade when pressure is removed. On darker skin, look for an area that is darker, purplish, warmer, firmer or more tender than the skin around it.

Moisture from urine, stool or sweat weakens skin. Prompt cleaning and a barrier product, when the clinician recommends one, help protect it. See our guide to managing incontinence and skin protection.

How Gateway arranges prevention at home and in facilities

At home, the plan has to fit the people who carry it out. Gateway shares the clinician’s instructions with family caregivers, home health and home care staff so everyone follows the same schedule. Primary care has a part as well, through regular skin checks and pressure injury prevention and attention to nutrition and healing.

In skilled nursing, assisted living, memory care and rehabilitation settings, prevention is part of the facility’s daily routine. During facility wound rounds, the treating clinician can review residents at risk, look at early skin changes and update orders for nursing staff.

How to start and what to report

Patients, families and caregivers can call 314-325-0126 or request care online. No referral is needed to ask, and the form takes contact details only.

Do not wait for a scheduled visit if you see a discolored area that does not fade, a blister, broken skin over a bony area, or new pain in a spot that bears weight. Call the treating clinician’s office. For an emergency, call 911.

Common questions

Can a pressure injury form in a wheelchair or recliner?

Yes. Sitting puts body weight on a small area around the tailbone and sitting bones, and sliding down in a recliner drags on the skin. The treating clinician may recommend a seat cushion and a routine for shifting weight. If a mark appears, our guide to pressure injury stages explains the terms clinicians use.

Is turning every two hours right for everyone?

Not necessarily. Every two hours is a familiar starting point in many care settings, but the treating clinician adjusts the schedule to the person’s risk, skin condition, comfort and support surface. Ask for the schedule in writing and post it where every caregiver can see it.

Can every pressure injury be prevented?

No. Good prevention lowers the risk, but some injuries develop even with attentive care. This is more likely during serious illness or when a person cannot tolerate being moved. Any new injury should be assessed by a clinician, and the prevention plan reviewed.

Does my family member need a special mattress?

Maybe. The treating clinician decides based on risk, existing skin damage and how much the person can move on their own. Options range from foam overlays to powered air surfaces. Benefits depend on your plan, the treating provider and the equipment ordered.

I found a red spot that does not fade. What should I do?

Keep the person’s weight off that area as much as you can, and do not rub or massage it. Then call the treating clinician’s office and describe where the spot is, how large it looks and when you first saw it. Early reports let the clinician adjust the plan before the skin opens.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.

Pressure injury prevention at home and in facilities.