3.3 Identify any concerns with the agreed care plan prior to undertaking the pressure area care

This guide will help you answer 3.3 Identify any concerns with the agreed care plan prior to undertaking the pressure area care.

An agreed care plan is a document created with the individual, their family, and professionals. It describes the support, treatments, tasks, and goals for someone receiving care. The plan considers their health, preferences, needs, and wishes.

Before giving pressure area care, such as helping someone change position or checking their skin, it is important to read the agreed care plan thoroughly. This helps everyone follow the same approach and respect the person’s choices.

Every worker must recognise if there are any issues with the care plan before starting. This protects both the individual and the worker and helps keep care effective and safe.

Why Review for Concerns?

Reviewing the care plan before starting pressure area care helps:

• Spot anything unsafe or unclear
• Notice changes in the individual’s needs
• Avoid causing pain, discomfort, or harm
• Respect consent and the individual’s dignity

By checking the plan for problems, you support good practice, prevent errors, and respond quickly to any concerns.

Common Concerns with Care Plans

There are several types of concern a worker might find when looking at an agreed care plan:

Conflicting or Missing Information

Sometimes the care plan contains unclear or conflicting instructions. For example, there may be two different turning frequencies given for repositioning, or information about allergies may be missing.

Conflicting or missing details can affect care quality. If this happens, clarify with your supervisor or key worker before continuing.

Outdated Details

Individuals’ needs can change often. Their weight, mobility, mental capacity, skin condition, or risks may change. If the plan has not been updated, the pressure area care instructions may no longer fit the person’s situation.

For example:

• A person now uses a different wheelchair
• New medicines are being used
• The individual now has less ability to move

If you notice dated information, raise this with the responsible member of staff.

Incomplete Risk Assessments

A care plan should include a risk assessment for pressure ulcers. This is often done by using a tool such as the Waterlow Score.

If you see no risk level recorded, or if details of the person’s nutritional status, mobility, and continence are missing, the plan may not be fit for purpose. This could increase risk of harm.

Lack of Consent or Choice

Pressure area care is a type of personal care. The person receiving care must have given their consent. If consent is not recorded, or the plan does not show their preferences, you must check what their wishes are. This respects their rights and avoids unwanted care.

Inappropriate or Unsafe Equipment

The plan might list equipment for repositioning, such as hoists or specialist mattresses. If the equipment is broken, missing, or poorly described, it can make care unsafe and uncomfortable.

Check the care plan for up-to-date and correct equipment details.

Checking the Individual’s Needs Match the Plan

You might spot that the person’s situation has changed since the plan was written. For example:

• The person has lost or gained weight
• They have new red or sore skin areas
• They are in more pain or distress
• Their movement is limited or has increased
• There has been a change in continence

If you see these signs—whether during your initial check or as you talk to the individual—you must speak up. Care should be based on what the person needs now, not just what’s written in the plan.

Examples of Concerns Prior to Pressure Area Care

Let’s look at examples of how concerns might appear:

Example 1: Changing Skin Condition

You read the care plan. It last recorded skin condition one week ago as ‘intact, no marking’. When you greet the person, you notice their heel has a red area which was not mentioned.

Action: Raise the concern with your senior. Do not continue with care without reviewing the risk. There may be a new pressure ulcer risk.

Example 2: Movement Restrictions

A person’s plan says they can assist when being turned. Today, you find they are weaker and say they have been unwell overnight.

Action: Work within your skills and training. If you cannot move the person safely as planned, pause. Get advice from a senior or therapist, as more support or equipment may be necessary.

Example 3: Broken Equipment

The plan lists a pressure-relieving mattress. You start, but the mattress pump is not working and feels flat.

Action: Do not risk using broken equipment. Record the problem, report it, and arrange a replacement. In the meantime, reposition the person more frequently and document what you have found.

Example 4: Conflicting Instructions

The plan says to turn the individual every two hours, but a notice on the wall says every four hours.

Action: Check with the person in charge. Always follow the agreed plan or updated clinical advice.

Steps to Take if Concerns Are Identified

If you find problems with the care plan, it is important to act responsibly and communicate well.

Immediate Actions

• Stop and do not start pressure area care until it is safe and clear
• Talk to the individual (if they are able) and explain what you have found
• Report the issue using your organisation’s procedures (often to a senior care worker or nurse)
• Record the concern in the person’s care notes

Why Must You Report?

Taking action protects the individual from harm. It prevents small risks from becoming serious incidents. It shows you follow your professional and legal duties. Ignoring concerns could lead to harm and disciplinary action.

Supporting the Individual’s Rights and Preferences

Reading the care plan also helps confirm that the person’s wishes, choices, and dignity are fully considered.

Check that the plan:

• Uses the person’s preferred name or title
• Explains how to respect privacy during care
• Lists any religious or cultural needs (e.g. same-gender staff, prayer times, covering the body)
• Displays clear consent for the type and frequency of care

If you find any gaps or concerns relating to the person’s rights and preferences, speak up.

Communication and Team Working

All care is a team effort. It is important that everyone involved knows the latest care plan, concerns, and changes.

When you spot a concern:

• Update all necessary members of the team
• Confirm with your colleagues that they are aware
• Share information clearly and accurately
• Always maintain confidentiality. Only share details with those who need to know.

Good communication supports safe, respectful pressure area care.

Accurate Record Keeping

If you find a concern, recording the detail in the individual’s care records is key.

Note:

• What the issue was
• When you noticed it
• Who you informed
• What actions were taken
• Any effect on the care given

Records should be fact-based, clear, and up to date.

Policies, Procedures and Training

Your organisation will have its own procedures about reviewing care plans before providing care. This might include:

• Using a checklist before starting care
• Documenting any concerns quickly
• Contacting supervisors for advice
• Following ‘duty of candour’ guidelines (being open and honest when things go wrong)

You must complete relevant training, understand your responsibilities, and follow all policies.

If you find you are not confident in pressure area care, or in reviewing care plans, request more training or supervision.

Legal and Ethical Responsibilities

Laws such as the Care Act 2014, Health and Social Care Act 2012, and the Mental Capacity Act 2005 apply.

Key points:

• Only deliver care that the plan allows and the person consents to
• Respect the individual’s choices, privacy, and dignity
• Raise safeguarding concerns if you believe the person is at risk

Failure to spot and report concerns can have legal consequences for both you and your employer.

Advocacy and Person-Centred Care

Advocacy means supporting the person’s voice and right to decide their care. Your responsibility is to notice and raise any issues that might affect their comfort or wellbeing. Person-centred care means seeing the individual as a unique person with particular needs.

Checking for concerns before pressure area care is part of person-centred working.

Supporting a Safe and Respectful Service

Workers play a key role in preventing harm from pressure ulcers by following and questioning care plans. Showing curiosity, attention to detail, and responsibility helps protect each person’s health.

Confidence develops with practice, team support, and using all information available from the care plan and the individual.

Raising concerns improves care, protects yourself, and supports the team. Always be clear, prompt, accurate, and respectful in all your actions and records.

Final Thoughts

Before providing pressure area care, take time to read and think about the agreed care plan. Look for any concerns such as missing consent, wrong risk level, outdated information or broken equipment. If anything is uncertain, stop, speak up, and record your concerns.

This protects the person receiving care, upholds your legal and professional duties, and helps deliver the highest standards of practice in your setting.

If you are ever unsure, remember to ask for help. Keeping the individual’s wellbeing at the centre of every decision is the main goal.