Assessment of skin breakdown

Early identification of the skin injury

Intensive short-term investment at an early stage can prevent ongoing deterioration of the area and the prolonged presence of pressure injury.

• History: explore when the area of concern developed, whether it is new or recurrent, if there was any change to the routine or equipment, or whether a contributing event, such as a fall or deflated cushion may have occured.
• Staging: determining the stage of a pressure area is important for developing a management plan, monitoring progression or healing, facilitating communication and assisting in documentation. If the area is red and it does not fade within 30 minutes, then this is a stage one pressure injury. More information on pressure injury staging can be found in this free poster from the National Pressure Injury Advisory Panel website: NPIAP pressure injury and stages poster.
• Skin changes: Treat any change to the skin as a cause of concern. This is crucial if it is close to or over a bony prominence. Changes can include pimples, rashes, scrapes, burns or bruises.

Identify correct body location

An accurate assessment of the location of skin breakdown is crucial in devising a management plan. Skin breakdown commonly occurs over bony prominences, such as a greater trochanter or ischium.

The ischium can be located by bending the knees up into a 90-degree position in side-lying. The ischium is located at the centre of the buttock at the lowest position. The greater trochanter will be lateral to the ischium.

Common areas of skin breakdown: ischium and greater trochanters.

Image source: QSCIS

Locating the ischium in side-lying.

Image source: QSCIS

Identify the cause

• Try to problem-solve why the skin breakdown occurred. This will assist with preventing future issues and provide an opportunity to seek assistance with any urgent changes to the routine or equipment.
• Manage intrinsic factors, such as nutrition, diabetes management, spasticity, joint range and oedema.

Seek help

• The goal is to perform a holistic objective assessment to review the wound care, causative factors and monitor the progress of the wound. This will determine the best progression for returning to sit, once healed.
• Partner with the person and be realistic about goals and outcomes.
• Seek early assistance and advice from the QSCIS team.