The dressing change is the moment that matters most, because it’s the only time anyone sees the wound. Take a deliberate look at every change. Check the wound for increased redness, swelling, or a bad odor. Pay attention to the color and amount of drainage from the wound. Look for drainage that has become darker, thicker or foul smelling.
Notice that every one of those signs is a comparison. Increased. Darker. Thicker. The question is never whether a wound looks bad (most of them do) but whether it looks worse than it did.
In practice, that means the useful record is the one kept over time. A note of how much drainage the dressing was soaking up last week, or what color it was, is what makes a change visible. Without it, every change gets judged against a memory.
The reasons to contact a provider are the same across different kinds of wounds: worsening redness; more pain; swelling; bleeding; a wound that is larger or deeper; a wound that looks dried out or dark; drainage that is increasing, that is not decreasing after 3 to 5 days, or that becomes thick, tan, yellow, green or smells bad.
For a pressure sore: if the pressure sore changes or a new one forms, tell the provider. Stage I is a reddened, painful area that does not turn white when pressed. That’s what a new one looks like before it opens.
Some signs aren’t on the wound at all. Fever and chills are signs of infection for several wound types, and for diabetic foot ulcers, so is increased firmness around the wound. In people with diabetes or pressure ulcers, infection may cause less obvious redness but more pain, swelling or general illness.
A person who seems unwell in themselves, when the wound looks much as it did, is a change worth reporting too.