Before the Wound Appears: Looking Beyond Pressure Offloading

This is the reality I see in aged care.

When a pressure injury occurs, we become very good at reacting. The wound nurse is involved, the mattress is upgraded, pressure care increases and the whole team focuses on healing the wound.

But what happened before the wound appeared?

In a busy care environment, frontline workers are balancing showers, toileting, transfers, meals and activities. A standard wheelchair intended only as a transfer aid can gradually become the resident's chair for the day because it is practical and readily available.

For a resident who can no longer stand or independently reposition, this becomes much more than an offloading issue. Is the wheelchair appropriate? Is the seat depth adequate? Is the resident sacral sitting? What shear forces are occurring? Was the change in standing ability communicated promptly? Did that change trigger a new pressure injury risk assessment and seating review?

When we simply say, “staff did not provide adequate pressure offloading,” we risk stopping the investigation at the frontline worker. The resident may actually have fallen through several gaps in the system.

Pressure injury prevention needs to be understood as a system—not a series of isolated interventions. Early recognition of mobility changes, timely reassessment, appropriate seating, clear communication and coordinated action all need to work together before skin damage occurs.

This is the thinking behind ROSE: helping aged-care organizations identify where residents may be falling through gaps and strengthen the pathway from early risk recognition to preventive action.