Abstract
<ns5:p> <ns5:bold>Background: </ns5:bold> </ns5:p> <ns5:p>In the UK around 700,000 people are living with pressure ulcers (also known as bedsores). Pressure ulcers impact on wellbeing and quality of life and result in high financial cost to the NHS and social care. It is generally agreed that nurses oversee the care and treatment of pressure ulcers in people's homes. It is unclear who is responsible for preventing pressure ulcers for people in their own homes. </ns5:p> <ns5:p/> <ns5:p> <ns5:bold>Aims: </ns5:bold> </ns5:p> <ns5:p> This study builds on our previous NIHR-funded research. It will inform future research to test out ways to support pressure ulcer prevention. We sought to: <ns5:list list-type="bullet"> <ns5:list-item> <ns5:p>Identify who has a role in pressure ulcer prevention, how this happens (e.g. giving advice, providing care, involving other practitioners), and what helps and hinders (i.e. barriers and facilitators). </ns5:p> </ns5:list-item> <ns5:list-item> <ns5:p>Bring together an expert team to develop a Programme Grant application, which is now in the final stages of development.</ns5:p> </ns5:list-item> <ns5:list-item> <ns5:p>Build a network of health and care practitioners and members of the public who are interested in our research, who have helped us shape and will be able to work with us on the Programme Grant.</ns5:p> </ns5:list-item> </ns5:list> </ns5:p> <ns5:p> <ns5:bold>Methods:</ns5:bold> </ns5:p> <ns5:p>We carried out a national survey and qualitative interviews with health and care practitioners who could support pressure ulcer prevention and with patients and their families. </ns5:p> <ns5:p/> <ns5:p>To build our network, we spoke to people from a range of organisations involved in pressure ulcer prevention, or who our research suggested might contribute to delivery of the intervention.</ns5:p> <ns5:p/> <ns5:p> <ns5:bold>Results: </ns5:bold> <ns5:list list-type="bullet"> <ns5:list-item> <ns5:p>Who influences and how</ns5:p> </ns5:list-item> </ns5:list> A total of 199 people responded to our survey and we interviewed 17 people. We found that most groups of practitioners were involved in ‘hands off’ tasks. Examples included referring patients to others or giving advice. Fewer groups were responsible for taking action, including supporting patients to change position, helping with eating and drinking, and applying skin care products. We also found differences between what groups of practitioners, patients and family members believed they should be doing, and what others thought their role involved. For example, Occupational Therapists, Tissue Viability Nurses and General Practitioners said they did less to prevent pressure ulcers than other groups thought they did. </ns5:p> <ns5:p/> <ns5:p> A lot of barriers and facilitators (factors which helped and hindered) to delivering pressure ulcer prevention were reported. These included: <ns5:list list-type="order"> <ns5:list-item> <ns5:p>A lack of knowledge and skills. Whilst some family carers learned a lot from some practitioners, others felt they had to seek out information themselves. Access to training for practitioners was not always thought to be of high quality and was described as ‘vague’. Practitioners and family members learned about pressure ulcers through experience and from trusted colleagues.</ns5:p> </ns5:list-item> <ns5:list-item> <ns5:p>Patients didn’t always see the same staff, and staff felt that this lack of continuity meant that they were not always best able to coordinate patient care.</ns5:p> </ns5:list-item> <ns5:list-item> <ns5:p>Pressure ulcers are often considered a taboo subject and therefore not openly discussed so missing opportunities for prevention.</ns5:p> </ns5:list-item> <ns5:list-item> <ns5:p>Most people understood the importance of preventing pressure ulcers for the individual and some considered the financial impact on the NHS. Whilst there were positive impacts for practitioners of preventing pressure ulcers (e.g. pride when care went well), there were also negative consequences in the form of blame when practitioners were believed to have delivered less than optimal PU prevention care.</ns5:p> </ns5:list-item> <ns5:list-item> <ns5:p>Lack of finance and availability of required equipment hindered care as did challenges in referring patients to specific services.</ns5:p> </ns5:list-item> <ns5:list-item> <ns5:p>Reminders for patients and family carers and building PU prevention activities into day-to-day routine, reminders for practitioners such as care plans and other paperwork (e.g., fluid intake charts) could be helpful. </ns5:p> </ns5:list-item> </ns5:list> <ns5:list list-type="bullet"> <ns5:list-item> <ns5:p>Our network </ns5:p> </ns5:list-item> </ns5:list> We have built networks to support our developing Programme Grant application. We have worked with academic and lay colleagues to develop our application. We have engaged with people and communities affected by the research, and we are working with health and care practitioners and leaders involved in pressure ulcer prevention. </ns5:p> <ns5:p/> <ns5:p>All the people we have spoken to fully support this programme of work, and we will continue to develop relevant relationships as our plans progress.</ns5:p> <ns5:p/> <ns5:p>We are in the final stages of preparing a PGfAR and plan to submit this in July 2026. </ns5:p> <ns5:p/> <ns5:p> <ns5:bold>Conclusions: </ns5:bold> </ns5:p> <ns5:p>A wide range of health and care practitioners visit older people living at home. Many saw themselves and others as involved with pressure ulcer prevention tasks. However, most gave advice, but far fewer provided practical help. This shows a need for an intervention to support pressure ulcer prevention care and self-care in the community. We have built a wide and varied network of experts to support this next step. </ns5:p> <ns5:p> <ns5:bold>Impact: </ns5:bold> </ns5:p> <ns5:p>The networks developed in this study are supporting us to develop a Programme Grant application. This project will test ways to support pressure ulcer prevention for older people living at home. This will include co-design with people to decide who delivers this. </ns5:p> <ns5:p/> <ns5:p>It is clear from our research that it is not clear who is responsible for pressure ulcer prevention. This study gives an explanation for this. As our PPIE representative said, ‘everyone but no-one' is responsible. We will share these findings with relevant stakeholders to clarify the roles and responsibilities of different practitioner groups in pressure ulcer prevention in the community.</ns5:p>