Pressure Ulcer Staging

A pressure ulcer is localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), resulting from sustained pressure (including pressure associated with shear). The damage can be present as intact skin or an open ulcer and may be painful.

Stage 1

pressure ulcer stage1

Non-blanching erythema of intact skin.


Stage 2

pressure ulcer stage2

Partial thickness skin loss involving epidermis, dermis or both. Superficial and presents as blister or abrasion.


Stage 3

pressure ulcer stage3

Full thickness skin loss involving damage / necrosis of subcutaneous tissue may extend to underlying fascia.


Stage 4

pressure ulcer stage4

Extensive destruction, tissue necrosis, damage to muscle, bone, supporting structures +/- full thickness skin loss.


NHS Improvement’s national Stop the Pressure programme has developed a guide to support nurses and other healthcare professionals in preventing pressure ulcers. The recommendations in our guide will support an organisation’s ability to learn from reported incidents and looks at ways to improve the prevention of pressure damage.

If patient has pressure ulcers ask yourself – could this be neglect?

In January 2018 The Department of Health and Social Care have released a ‘Safeguarding Adults Protocol’ providing a framework for health and care organisations to draw on when developing guidance for staff in all sectors and agencies that may see a pressure ulcer.

If the staff member is concerned that the pressure ulcer may have arisen as a result of poor practice, neglect/abuse or an act of omission, the local guidance should be clear about what steps they need to take and whether the local authority safeguarding duties are triggered.

NB: Some areas of health use a slightly different categorisation based on European Guidelines