Stage 1 pressure ulcers are the earliest and most subtle form of pressure-related skin injuries, but they are also the most critical to catch early. This guide explores everything you need to know about stage 1 pressure ulcers—from how to identify them, common causes and risk factors, to the best practices for treatment and prevention in long-term care settings. Whether you're a caregiver, nurse, or facility leader, recognizing and responding to the first signs of a stage 1 pressure ulcer can make a significant difference in patient outcomes and overall skin integrity. Keep reading to learn how to protect vulnerable residents and promote healing before more severe stages develop.
Introduction
A pressure ulcer is defined as damage to skin or underlying soft tissue that may be over a bony prominence. The damage occurs due to prolonged or severe pressure or due to the combination of pressure and shear. It is important to diagnose pressure ulcers early to avoid worsening or complications such as infections, which can be life-threatening.
What Is a Stage 1 Pressure Ulcer?
A stage 1 pressure ulcer is a pressure-related injury of intact skin with the presence of non-blanchable redness, which may appear a different shade on darkly pigmented skin (blue or purple). Stage 1 pressure ulcers commonly occur over bony prominences such as buttocks, elbows, heels, or the sacrum. Many residents are at high risk of developing stage 1 pressure ulcers due to obesity, dehydration, malnutrition, and low body weight. Other risk factors include urinary or bowel incontinence, joint contractures, poor circulation, peripheral neuropathy, rashes, and cognitive impairment.
Early Warning Signs of Stage 1 Pressure Ulcers
Some early signs of stage 1 pressure ulcers include skin color changes (red, blue, or purple) that do not fade when pressure is applied to the area. The skin may also be warm, swollen, or firm, and the resident may complain of pain or itchiness in the area. The skin texture might also change and feel boggy.
How to Treat a Stage 1 Pressure Ulcer
Once a stage 1 pressure ulcer is identified, prompt and proper treatment is essential to prevent further skin breakdown. Follow these best practices to promote healing:
- Relieve Pressure Immediately: Reduce pressure on the affected area by repositioning the resident frequently. Use pressure-relieving devices such as cushions, pillows, or specialized mattresses.
- Protect the Skin: Apply appropriate dressings or padding to shield the area from friction, moisture, and further pressure. This also helps create a moist wound-healing environment.
- Maintain Skin Cleanliness and Hydration: Gently cleanse the area and apply moisturizers to keep the skin supple and reduce the risk of progression.
- Monitor for Changes: Track the condition of the pressure ulcer daily. Any signs of worsening, such as increased redness, warmth, or skin breakdown, should be addressed immediately.
- Consult Clinical Experts: Involve a certified wound care nurse, physician, or other qualified clinical leadership if the ulcer does not show improvement within a few days or appears to worsen.
Early and consistent intervention is the key to healing stage 1 pressure ulcers and avoiding more serious complications such as stage 2 ulcers or infections.
Preventing Stage 1 Pressure Ulcers
Prevention is the most effective way to reduce the incidence of stage 1 pressure ulcers in nursing homes and other long-term care settings. Facilities should implement comprehensive, evidence-based strategies to protect at-risk residents:
- Reposition Residents Regularly: Follow a consistent repositioning schedule for all residents identified as high risk. Frequent position changes help reduce prolonged pressure on vulnerable areas like the heels, sacrum, and elbows.
- Conduct Routine Skin Assessments: Perform full-body skin checks at least weekly to identify early signs of pressure-related damage. Early detection of redness or warmth can prevent progression.
- Use Risk Assessment Tools: Utilize validated risk assessment tools such as the Braden Scale on a regular basis to identify residents most vulnerable to developing pressure ulcers.
- Monitor Nutrition and Hydration: Track residents' weight and ensure they receive adequate nutrition and fluid intake. Malnutrition and dehydration significantly increase the risk of skin breakdown.
- Utilize Pressure-Relieving Devices: Equip beds and wheelchairs with pressure-relieving mattresses, cushions, or overlays for residents at high risk of skin breakdown.
- Ensure a thorough care planning process: Individualize a resident's care planning following a holistic approach to prevent skin breakdown. Interventions should include efforts to stabilize, reduce, or remove underlying risk factors; to monitor the impact of the interventions; and to modify the interventions as appropriate based on the individualized needs of the resident.
By focusing on these proactive prevention measures, facilities can reduce the occurrence of stage 1 pressure ulcers, improve resident outcomes, and support a culture of skin integrity.
How do Stage 1 Pressure Ulcers Affect Quality Measures?
Stage 1 pressure ulcers do not affect a nursing home's quality measures. Prevention is key! Once pressure ulcers become a stage 2-4 or are unstageable, they will affect the long-stay percentage of residents with pressure ulcers and/or short-stay percentage of residents with pressure ulcers that are new or worsened, which also affects the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) measure.
Building a Facility-Wide Culture of Skin Integrity
Sustainable prevention and treatment of stage 1 pressure ulcers begins with a strong, facility-wide commitment to skin health. Leadership plays a critical role in shaping a proactive and collaborative approach:
- Make Skin Integrity a Core Value: Facility leadership should emphasize the importance of skin integrity across all departments. When preventing pressure ulcers becomes a shared responsibility, care outcomes improve.
- Foster Interdisciplinary Collaboration: Encourage teamwork between nursing, dietary, therapy, housekeeping, and administrative staff. A coordinated approach ensures that prevention and treatment strategies are implemented consistently.
- Provide Ongoing Staff Education: Offer regular training on pressure ulcer staging, prevention techniques, and treatment protocols. Conduct hands-on competency assessments to reinforce best practices.
- Monitor and Share Data Transparently: Track the facility's pressure ulcer rates—including new or worsening stage 1 pressure ulcers—and share findings during Quality Assurance and Performance Improvement (QAPI) meetings. Use this data to drive targeted improvement plans.
- Encourage Open Communication: Create a safe environment where staff feel empowered to report skin concerns or suggest improvements without fear of blame.
- Celebrate Successes: Recognize and celebrate milestones, such as reductions in pressure ulcer rates or successful healing of existing ulcers. Positive reinforcement boosts morale and maintains momentum.
By establishing a culture that prioritizes skin integrity, facilities can more effectively prevent stage 1 pressure ulcers, ensure early treatment, and enhance overall resident care.
Conclusion
Stage 1 pressure ulcers are preventable skin injuries that occur to intact skin due to prolonged or intense pressure or due to pressure in combination with shear. Many nursing home residents are particularly at risk of developing pressure ulcers due to their complex medical conditions and poor nutrition. To treat the ulcer, staff should protect and relieve pressure from the affected area using cushions, bolsters, or dressings. Facility leadership should ensure skin assessments are done frequently and all residents are screened regularly for their risk of developing stage 1 pressure ulcers. It is essential that all staff understand the importance of recognizing stage 1 pressure ulcers early to prevent worsening or life-threatening complications.
Frequently Asked Questions (FAQ)
- Can stage 1 pressure ulcers heal on their own? Yes, stage 1 pressure ulcers can heal if pressure is relieved from the affected area and the area is treated appropriately.
- How long does it typically take for a stage 1 ulcer to heal in a long-term care resident? Healing time depends on many factors such as size, location, and underlying health conditions. Some stage 1 pressure ulcers can heal in a few days, while some might take longer.
- What is the difference between stage 1 and stage 2 pressure ulcers? Stage 1 pressure ulcers involve intact skin, while stage 2 pressure ulcers involve loss of skin with a wound bed.
- What role do CNAs play in preventing pressure ulcers? CNAs play an essential role in preventing pressure ulcers by repositioning at-risk residents and alerting nursing staff to any skin changes. CNAs can also ensure that residents receive adequate nutrition and hydration.
- How can leadership support better pressure ulcer outcomes? Facility leadership can play a role in creating a culture that prioritizes skin integrity. Leadership should ensure that policies and procedures are in place for resident screenings that determine pressure ulcer risk as well as regular skin assessments. Leadership should also ensure that success stories and improvement in pressure ulcer rates are celebrated and shared with staff to maintain momentum and encourage continued excellence in skin care.
