16 Mar 2021

Clinical Negligence

Avoid debilitating bed sores this National Bed Month

March is National Bed Month, an annual initiative to raise awareness of sleeping well and to promote the importance of sleeping in a good bed. However, choosing the right bed is not only important for the many people who struggle with their sleep. It is also vital for the thousands of incapacitated patients and care home residents across the UK who are forced to spend long periods in their beds, often developing incredibly painful and debilitating pressure ulcers as a result.

Debra King, an associate paralegal in our Clinical Negligence team, explains why this is such an important issue.

Commonly known as “bed sores”, pressure ulcers are one of the most common problems in people with limited mobility. They can often cause severe pain, take months to heal and have a huge impact upon your overall health. In many cases, pressure ulcers can cause a patient’s 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.

The cost of treating a pressure ulcer is also significant, costing the NHS more than £3.8 million every single day.

In recognition of National Bed Month, we have compiled a short guide to help if you are concerned about someone you know developing pressure ulcers.

Q: What is a pressure ulcer?

Pressure ulcers 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.  Initially they develop as a ‘localised injury to the skin and/or underlying tissue’ which causes significant pain and discomfort, but if left untreated, they often develop into open wounds or ulcers.

Q: How common are pressure sores?

A: Between 4 and 10% of all hospital patients are thought to develop pressure ulcers. That’s over 1300 NHS patients per month but even that does not tell the whole story as this figure does not include care home residents or those in community care.

Pressure ulcers can affect any part of the body but are most common on bony parts such as the hips, buttocks, heels, elbows and base of the spine.

Q: Who is most likely to develop pressure sores?

A: Older people are the most likely group to develop pressure ulcers, but 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 ulcer 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.

Pressure ulcers can be caused by other factors too, not only a lack of mobility. 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 ulcers preventable?

A: Yes, the vast majority of pressure ulcers can be prevented if proper procedures are followed by carers in residential homes or by nursing staff in hospitals. Every patient should be assessed for the risk of developing a pressure ulcer.  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 ulcers from developing in the first place.

The same is true if someone in your family is bedbound at home. Encourage them to keep moving as much as possible, changing position at least every two hours. Help them to stand up to relieve pressure if they can and use special pressure relieving mattresses and cushions wherever possible.

Sometimes, if a patient is very ill patient or in a lot of pain, they will refuse to be repositioned but usually, if you or the carer explains the risks of pressure damage and adequate pain relief or anti-sickness medication is given, the patient will readily agree to be turned, which helps to 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 septicemia 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 the NHS website.

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