When should I consider referring a patient with a pressure ulcer to a specialist for further management?

Consider referring a patient with a pressure ulcer to a specialist for further management if:

• There is clinical evidence of systemic infection such as systemic sepsis, spreading cellulitis, or underlying osteomyelitis requiring systemic antibiotics, which should be guided by microbiology advice ¹,³.
• The pressure ulcer is not healing or is worsening despite appropriate initial management, including pressure relief, wound care, and nutritional support ¹,³.
• The ulcer is complex, large, or deep (Category III or IV), or there is significant necrotic tissue requiring specialist assessment for possible debridement ¹,³.
• The patient has comorbidities or factors complicating management, such as impaired mobility, neurological impairment, or vascular insufficiency, which may require multidisciplinary input ¹,³.
• There is a need for advanced wound care techniques or devices not available in primary care, such as dynamic support surfaces or specialist dressings ¹,³.
• There is uncertainty about diagnosis, or the ulcer may have an atypical cause requiring specialist assessment (e.g., dermatology or vascular specialist) ¹,³.

Referral pathways should be based on local resources and expertise, with involvement of tissue viability nurses, dietitians, microbiologists, and other specialists as appropriate ¹,³.