2.2 Describe agreed ways of working relating to pressure area care

This guide will help you answer 2.2 Describe agreed ways of working relating to pressure area care.

Agreed ways of working guide how you provide care. These are set out in your workplace policies, procedures, care plans and best practice guidance. They help you follow legislation and standards in your daily work. For pressure area care, agreed ways of working reduce risk and improve outcomes for people receiving care. In this guide, we will cover what these agreed ways of working mean and how you put them into practice.

Understanding Pressure Area Care

Pressure area care means preventing or treating damage to the skin and tissues, commonly called pressure ulcers or bedsores. Pressure ulcers form when skin and underlying tissue are damaged by continuous pressure, friction, or rubbing. People who are lying or sitting in one position for a long time are at higher risk.

People at risk include:

• Older adults
• People with limited movement
• Anyone with reduced sensation or mobility
• People with poor nutrition or hydration

Agreed ways of working in pressure area care help identify risks, prevent skin damage, and manage any problems early.

Legal and Regulatory Context

Your agreed ways of working should comply with:

• The Health and Social Care Act 2008
• The Care Quality Commission (CQC) regulations
• Manual Handling Operations Regulations 1992
• The Human Rights Act 1998
• NICE (National Institute for Health and Care Excellence) guidelines
• Your employer’s policies and procedures

Following these standards protects both the people you care for and yourself.

Key Agreed Ways of Working

Procedures and policies for pressure area care describe the steps you must follow. These are agreed by your organisation and are based on up-to-date guidance. They often appear in your staff handbook or training material. The main agreed ways of working are:

• Carry out regular risk assessments
• Record observations accurately
• Follow the care plan
• Use appropriate equipment and techniques
• Work safely and report concerns
• Promote person-centred care
• Maintain good communication
• Maintain dignity and privacy
• Report and record skin changes
• Access training and maintain skills

Below, I explain each one in more detail.

Risk Assessment

You must check each person’s risk of developing pressure ulcers. Common tools in agreed ways of working include the Waterlow or Norton risk assessment charts.

What you need to do:

• Complete risk assessments when someone is admitted
• Update assessments regularly, or if there are changes
• Act quickly if someone is at higher risk

Look for:

• Changes in mobility
• Poor nutrition or hydration
• Medical conditions like diabetes
• Skin that is already red or broken

Document findings accurately. Notify senior staff or the nurse in charge if you see new risks.

Care Planning

Every person should have a care plan. This document records needs, goals and any actions required. Agreed ways of working require you to read, understand and follow the care plan.

Main steps:

• Check the care plan for instructions about turning, repositioning or using equipment
• Record every time you follow the actions
• Report any reasons if you cannot carry out a care plan step

Care plans help make sure that each person gets care that is right for them.

Repositioning and Movement

Reducing time spent in one position prevents skin damage. Your agreed ways of working will give a schedule for turning people in bed or helping them change position in a chair.

Common schedules:

• Turn every two hours for people at very high risk
• Every four hours if risk is lower

This may differ based on individual needs. Always:

• Use moving and handling techniques and equipment listed in the care plan
• Work with another colleague if required
• Record every repositioning in the care recording system or chart

Never move a person in a way that could hurt them or yourself. If you feel unsure, check the procedure or ask your supervisor.

Equipment and Support Surfaces

Your agreed ways of working will tell you what equipment to use. This might be:

• Pressure-relieving mattresses or overlays
• Cushions for chairs
• Heel protectors
• Bed cradles to keep sheets off sore skin

Make sure equipment is clean, in good condition, and used as instructed. Check before and after use for faults. If you spot a problem, report it straight away and record your actions.

Skin Inspection

Regularly checking the condition of the skin is a core part of pressure area care.

How to do this:

• Look at pressure points — buttocks, hips, heels, elbows, shoulders
• Check for redness, swelling, blisters or broken skin
• Gently feel for hard or warmer areas
• Document your observations in the care record

If you see any changes, however minor, inform your supervisor or nurse. Early action can stop an ulcer forming.

Personal Hygiene

Keeping the skin clean and dry protects it from damage. Your agreed ways of working will describe:

• Gentle cleaning using recommended products
• Patting dry, not rubbing
• Changing clothes or bedding if wet
• Avoiding strong soaps and scented creams

Always respect the person’s wishes and dignity. Support them to do as much as possible for themselves.

Nutrition and Hydration

Good nutrition and enough fluids help skin stay healthy. Pressure ulcer care policies may include:

• Monitoring food and drink intake
• Supporting with eating and drinking if needed
• Recording everything in the person’s notes
• Reporting reduced appetite or missed meals

Skin needs protein, vitamins and fluids to repair itself. Raise any concerns with your supervisor.

Using Protective Aids

Sometimes, staff need to use protective aids such as creams or dressings on vulnerable areas. Always:

• Follow instructions in the care plan
• Wear gloves if applying creams
• Record use of prescribed products accurately
• Never use products that have not been authorised

Check with a nurse or supervisor if you are uncertain.

Record Keeping

Accurate records are required by law and your employer’s policies.

Good record keeping means:

• Writing down actions clearly and promptly
• Using agreed terminology
• Reporting changes or concerns at once
• Signing and dating your entries

Do not record anything you did not do. If you make a mistake, follow your workplace correction procedure.

Communication and Reporting

You must communicate clearly with:

• The person receiving care
• Your colleagues
• Other health professionals

If you notice signs of discomfort, changes in skin condition or new risks, pass on this information straight away. Use your organisation’s reporting process for safeguarding or health and safety concerns.

If a person cannot speak for themselves, watch for signs like wincing, restlessness, or pulling away during care.

Person-Centred Working

Every person is different. Agreed ways of working require you to match your care to each individual’s wishes, needs, and preferences. This approach includes:

• Asking for consent before any care
• Listening to concerns and preferences
• Explaining what you are doing and why
• Allowing choice where possible
• Respecting privacy and dignity throughout

Use a sheet or towel to cover areas not being checked if you need to inspect the skin. Always shut doors or close curtains as appropriate.

Training and Safety

Your workplace must provide relevant training. You are responsible for attending training sessions and keeping your learning up to date. Training covers:

• How to spot and report early signs of skin damage
• Using specialist equipment
• Safe manual handling techniques
• Fire and electrical safety for pressure-relief devices

If you do not feel confident, seek advice before caring for someone at risk.

Infection Control

Agreed ways of working include infection prevention steps. These help protect both you and the person receiving care.

Follow:

• Hand hygiene before and after any contact
• Wearing gloves and aprons as instructed
• Safe disposal of waste and soiled dressings
• Cleaning equipment after use

Report any worries about infection or hygiene to your supervisor.

Working Within Own Limits

Recognising the limits of your role is a key agreed way of working. Only carry out tasks you are trained and allowed to do. For tasks outside of your role, you must ask your supervisor or a qualified nurse for guidance.

Do not diagnose or decide on treatment. Your responsibility is to follow the care plan and workplace procedures. If the plan is unclear, or if you are unsure what to do, highlight it at once.

Understanding Duty of Care

You have a duty of care to keep people safe from harm. This means you must act if you suspect someone is at risk. Pressure ulcer development can amount to neglect if care standards are not met.

If you spot:

• Repeated skin breakdown
• Missed care actions
• Unsafe equipment
• Inadequate staffing

Report immediately using safeguarding or whistleblowing procedures.

Consent and Shared Decision Making

Always seek consent. Explain what you plan to do before any pressure area care. Ask if the person is comfortable, needs support, or wants anything different. If someone refuses, record their wishes and tell the senior on duty.

People have the right to refuse care unless their safety is threatened. In those cases, the team must assess what is best, considering mental capacity and legal frameworks.

Reflective Practice and Continuous Improvement

You can help improve your practice by:

• Taking part in supervision and reviews
• Reflecting on what went well or could be done better
• Sharing feedback from people receiving care
• Learning from any incidents or audits

This supports better outcomes for those you look after.

Final Thoughts

These steps prevent harm, meet legal requirements, and support the wellbeing of people who rely on your care.

If you ever feel unsure, stop and check the agreed way of working. Seek help from a supervisor or named nurse. Following the policies protects everyone and improves the quality of care you provide.