19 Nov 2020

Clinical Negligence

A Guide to Pressure Ulcers

Today (19 November) is STOP Pressure Ulcer Day, a global annual event which brings together healthcare professionals, the public and the media to help raise awareness of an issue that affects thousands of hospital patients and care home residents every year. Debra King, an associate paralegal in our Clinical Negligence team, explains why this is such an important issue.

If you or your loved ones have ever suffered from “bed sores” or pressure ulcers, you will know how debilitating they can be. One of the most common problems in patients with limited mobility, they are not only incredibly painful and uncomfortable but they can also take months to heal and can have a huge impact upon your overall health.

As well as causing severe pain, pressure ulcers can cause your underlying condition to deteriorate, resulting in longer hospital stays, and in some cases can even be life threatening. In older patients, they are associated with a fivefold increase in mortality[i]. The cost of treating a pressure ulcer is also significant, costing the NHS more than £3.8 million every single day.

To mark STOP Pressure Ulcer Day, we have compiled a short guide to help if you are concerned about someone you know developing pressure sores.

Q: What is a pressure ulcer?

More commonly known as bed sores, they commonly develop in individuals who have experienced a period of limited mobility where their skin is pressed against a bed or a chair for a long period of time.  People often affected have been bed bound due to short term illness, surgery as well as those who are generally immobile.  They are a ‘localised injury to the skin and/or underlying tissue’[ii] which causes significant pain and discomfort.  If left untreated, they can develop into open wounds or ulcers.

Q: How common are pressure sores?

A: It is estimated that over 1300 patients per month[iii] develop pressures sores during NHS care. This does not include care home residents or those in community care.  Between 4 and 10% of all hospital patients are thought to develop pressure sores.[iv] Pressure ulcers can affect any part of the body but are most common on bony parts such as the hips, heels, elbows and base of the spine.

Q: Who is most likely to develop pressure sores?

A: While older people are the most likely group to develop pressure ulcers, they can affect anyone at any age where there is a period of immobility. They are particularly common in those who have suffered hip fractures, spinal injuries, are incontinent, smoke, have dry skin, chronic systemic conditions or are terminally ill.  The key factors in developing a pressure sore are:

  • Immobility
  • Pressure on the skin from hard surfaces or from muscle spasm
  • An inability to feel or limited sensory perception
  • Poor nutrition and hydration

The presence of friction or moisture are also contributory factors to developing pressure ulcers.

It is not only a lack of mobility which can cause pressure ulcers, however. For example, they sometimes develop where a cast has been fitted, which can be significant as they are often not identified until the cast is removed.

Q: Are pressure sores preventable?

A: The vast majority of bed sores can be prevented if proper procedures are followed by care or nursing staff. Every patient, whether in a hospital, care home or otherwise, should be assessed for the risk of developing a pressure sore.  Steps such as regular movements and repositioning, regular checks of the skin, anti-pressure bedding and mattresses as well as simple barrier creams can all be followed to prevent pressures sores from developing in the first place.

A common theme that we see in our pressure ulcer cases are patients being left in their bedside chair in hospital for too long without the appropriate pressure-relieving cushion.  Alternatively, sometimes a very ill patient or one in a lot of pain refuses to be repositioned but with an explanation of the risks of pressure damage and/or adequate pain relief or anti-sickness medication, the patient will readily agree to be turned, thus avoiding the pressure ulcer developing.

Q: How serious are different types of pressure ulcers?

A: There are 4 grades of pressure ulcer:

Grade 1:               At this stage only the upper layer skin has been affected.  The skin will have started to discolour, usually a darker shade and there may be some discomfort.  Sometimes the area will feel warm to the touch.  It is vital that steps are taken at this stage to prevent a pressure ulcer developing;

Grade 2:               There will now be an open wound or blister and the upper layers of skin are damaged.  There is a risk of infection.

Grade 3:               The wound is now bigger or deeper.  There is loss of skin and other tissue damage and more likely infection.

Grade 4:               This is the most serious stage of a bedsore. Almost all the skin surrounding the sore would be dead and muscles, tendons and can lead to septicaemia and amputation.

Q: I’ve heard that pressure ulcers are particularly serious for people with diabetes?

A: If you are diabetic, the complications arising from pressure ulcers can be far more significant as where there is already a risk of nerve damage (known as neuropathy) and poor blood circulation leading to reduced feeling, the threat of a pressure ulcer is even greater. The possible complications caused by the development of a pressure ulcer in a person with diabetes can be far more serious too, sometimes leading to septicaemia and even amputation.

Q: Am I entitled to compensation if I have developed a pressure ulcer?

Put simply, pressure ulcers should not occur. They are entirely preventable when the correct care, patient management procedures and equipment are in place. If you have suffered a pressure ulcer, no matter how minor, please contact us on 01633 244 233 within 3 years of the ulcer developing, and we will help you obtain the compensation that you deserve.

For further information on the different types of pressure ulcer and the symptoms to look out for, visit https://www.nhs.uk/conditions/pressure-sores/

[i] Gray 2006

[ii] NHS England – Atlas of shared learning

[iii] Website – nhs.stopthepressure.co.uk

[iv] MJ Open: first published as 10.1136/bmjopen-2016-015616 on 21 August 2017

 

 

 

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