Pressure sores are a significant issue of concern within our health care system.
According to NHS England the total cost of the problem is estimated to be between £1.4 billion and £2.1 billion annually. In nursing homes, it is estimated that 1 in 10 residents will suffer from pressure sores at any one time. On average, 2,000 pressure sores are newly acquired each month and up to 200,000 people developed a new pressure sores in 2017/2018.
What is a pressure sore?
Pressure sores, also known as bed sores, are areas of damaged skin. Pressures sores are a type of ulcer which develop in people who are immobile, bed-bound, or unable to feel pain. Elderly frail adults, as well as those with diabetes or problems with their blood circulation are at high risk of developing pressure sores. Patients with poor nutrition, cognitive impairment and who are unable to reposition themselves are also at risk.
The areas most likely to be affected by pressure sores are pressure points which bear the weight of the immobile patient, for example heels, shoulder blades, hips and buttocks.
How do pressure sores form?
Pressure sores occur when the blood supply to the affected area is reduced, due to external pressure. According to the UK’s National Pressure Ulcer Advisory Panel, there are 4 main stages of pressure sore:
1. Non-blanchable. Reddening and darkening of the skin over pressure points. This is an early indication that there may be damage to local blood vessels and deeper tissues. The patient may experience itching or burning. This stage may resolve in a few days.
2. Partial thickness. The skin is broken, forming a shallow ulcer. This can be very painful. These ulcers may heal within 6 weeks.
3. Full thickness skin loss. The ulcer extends deeper into the underlying tissue.
4. Full thickness tissue loss. The ulcer extends to muscle or further into bone. This presents a high risk of infection and surgery may be required to treat it properly. Pressure sores that reach stages 3 and 4 can take months to heal, but there is also a risk that they may never heal at all.
There are two additional categorisations: suspected deep tissue injury and unstageable, with full thickness skin or tissue loss.
What are the complications of pressure sores?
Pressure sores can be highly dangerous and indeed life threatening, as a result of complications. Infection of the skin, muscles and bone are real risks, for if the infection spreads into the blood it will cause sepsis. In wounds that do not respond to treatment over a prolonged period, there is also a risk of the ulcer cells turning cancerous.
Pressure sores can also lead to severe disabilities and even amputation of limbs. Hospital stays are protracted. Most of all, the pain and suffering of the patient can be severe.
How are pressure sores treated?
When a pressure ulcer develops, it should be closed as soon as possible. However, pressure sores can be very hard to treat. Depending on the severity of the ulcer and the patient’s overall health, they can take days to months to heal. Treatment varies but wound care can include debridement of dead tissue, keeping the wound protected and clean, antibiotics and if severe enough, skin grafting.
Prevention is much better than cure.
Florence Nightingale said, ‘If he has a bedsore, it’s generally not the fault of the disease, but of the nursing’. Although pressure sores can develop despite high quality care, they can be an indication of inadequate nursing care and possibly even neglect.
In recognition of the seriousness and prevalence of pressure sores in vulnerable patients, various acts and guidelines have been produced. In 2014, The National Institute for Health and Care Excellence (NICE) published detailed clinical guidelines regarding the prevention and management of pressure sores. In addition, the Care Act (2014) outlines the duties of local authorities in the care and support of adults, including safeguarding against abuse or neglect and making provision for adequate care standards. As related to pressure sores, the Act requires that guidance should be given to staff who are worried that, ‘A pressure ulcer may have arisen as a result of poor practice, neglect, acts of omission or deliberate harm’.
There are other nationwide initiatives to prevent and treat pressure sores, including the 2018 NHS Improvement Stop the Pressure and PROSPER: Promoting safer providing of care for elderly residents.
For all these guidelines and acts to mean anything in practice, staff in hospitals and in the community, including nursing homes must be trained in pressure ulcer prevention.
Prevention techniques can include:
· Daily monitoring of skin in vulnerable patients
· Regular turning and repositioning regimens
· Skin care including the use of specialised dressing
· Adequate nutrition
· Using specially designed cushions and mattresses
Pressure sores and medical negligence
Despite the widespread recognition of the risk from pressure sores and the recent healthcare initiatives, people are still developing pressure sores while under the care of nursing homes, district nurses and hospitals.
For a negligence claim to be successful, there must be evidence that there was a duty of care and that duty of care was breached, resulting in harm. In the case of pressure sores, taking legal action may be the best way to ensure that standards of care are improved not only for your loved one, but also for other vulnerable people in the future. If you think you or a loved one has suffered a pressure sore due to medical negligence, get in touch with one of our knowledgeable and experienced solicitors at Osborne’s Law.
Client Case Study
Our client (Mr B) was admitted into hospital following a neurological injury. One of his pressure sores was at the base of his spine and this sore developed and increased in size over several weeks and during this time he suffered pyrexia and despite this, there was no change to his 4 hourly turning regime. His condition deteriorated to such an extent that he was transferred to another hospital, for medical intervention.
Eventually our client was taken to theatre for a debridement of his pressure sore and part of the bone at the base of his spine had to be removed as a consequence of infection. It was not until months later that he was able to sit in a wheelchair for 35 minutes; this is 4 months after the surgery to his spine. Mr B remained in hospital a further number of months and then he was transferred to a Home where he still remains and although he has suffered chest infections he remains in reasonable health.
Stephanie Prior, medical negligence solicitor settled Mr B’s case following on-going negotiations and five figure damages were awarded. Nicholas Leahy secured the court’s approval of the award following a hearing at the Central London County Court.
Our Promise to You
· We will review your potential claim by advising you on the NHS complaints procedure or other alternative procedure if your case does not relate to NHS care and treatment.
· We will not charge a fee for our time in reviewing your case.
· We can assist you with any issues that you may have regarding the complaints procedure or that you encounter in obtaining copies of your medical records.
· We will advise you of the course of action in respect to your case.
To speak to Stephanie Prior or Nicholas Leahy call 020 7485 8811 for an initial confidential discussion.