21 Feb 2022
If you or your loved ones have ever suffered from ‘pressure sores’ or ‘bed sores’ (properly referred to as pressure ulcers), you will know how debilitating they can be. Pressure sores are not only incredibly painful and uncomfortable, they can also take months to heal and can have a huge impact upon your overall health.
Even when healed, significant pressure ulcers leave scar tissue which is more vulnerable to future pressure damage. This means that future pressure ulcers develop more easily where scar tissue already exists.
Pressure ulcers are not just limited to developing in hospitals – residential care and nursing homes also have patients who develop these nasty injuries.
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. A pressure ulcer is a damage to the skin and the deeper layer of tissue under the skin. This happens when pressure is applied to the same area of skin for a period of time and cuts off its blood supply.
Many people who are frail and have restricted mobility are at risk of developing sores on the points of their body that receive the most pressure. A common theme that we see in our pressure ulcer cases are hospital patients or care home residents being left in their bedside chair for too long without the appropriate pressure-relieving cushion.
Pressure sores are not always due to neglect and each individual case should be considered, taking into account the person’s medical condition, prognosis, any skin conditions and their own views on their care and treatment.
The vast majority of pressure sores can be prevented if proper procedures are followed by care or nursing staff. Every patient should be assessed for the risk of developing a pressure sore. There are steps such as regular movement and repositioning, regular checks of the skin, application of dressings, anti-pressure bedding and mattresses as well as simple barrier creams that can all be followed to prevent pressures sores from developing in the first place.
Debra recently represented Mr. B in a case where he had developed a serious pressure sore on his sacrum (base of his spine) and smaller pressure sores on both heels following a fall which had rendered him immobile for a period of time. In this particular case, after being discharged from the hospital to a care home, Mr. B was risk assessed as being at ‘high risk’ of developing pressure sores.
However, there were a number of occasions – documented in Mr. B’s records – where it was recorded that he had developed a pressure sore, but where there was no reassessment of his Waterlow score, and no re-evaluation of his care plan. There were no additional interventions added to the care plan in response to Mr. B’s documented pressure sores. The nursing records documented instances where Mr. B had complained of a sore bottom, and/or that he had been left sitting out for too long.
There were no turn charts (or equivalent) to demonstrate that an organised approach to pressure relief was implemented. There was no systematic or thorough review of the progress or deterioration of Mr. B’s pressure areas. There was no indication that the staff at the particular care home, in this case, appreciated the seriousness of Mr. B’s condition – in particular in respect of his sacral pressure sore. The pressure sore at the base of his spine would have been known to the staff caring for him because he was unable to wash his back and lower body unaided.
Eventually, Mr. B was admitted to hospital with sepsis, where hospital A & E staff noted the severity of the pressure sore on his sacrum in particular and raised their own concerns with the Social Services Safeguarding Team. Mr. B was subsequently discharged to a different care home but had a poor prognosis due to the fact that the sacral pressure ulcer would not heal, despite every effort being made to improve the situation. Unfortunately, he remained bed-bound. The care home in question admitted liability and this case settled in Mr. B’s favour. At the time of settling this case, the pressure ulcer had been present for nearly four years.
Every patient, whether in a hospital, care home or otherwise, should be assessed for the risk of developing a pressure sore.
Based on available data, new pressure sores are estimated to occur in 4–10% of patients admitted to hospitals in the UK. It is estimated that over 1300 patients per month 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. Pressure ulcers can affect any part of the body but are most common on bony parts such as the heels, elbows, ankles and base of the spine. They also commonly develop on the sides of the feet and the buttocks. Pressure damage can also develop underneath ill-fitting plaster casts which are routinely applied when fractured bones are sustained. These ulcers can be significant as they are not detected until the plaster cast is removed and would therefore have been present for some time.
Put simply, pressure ulcers should not occur. They are entirely preventable when the correct care, patient management procedures and equipment are in place.
For further information on the different types of pressure ulcers and the symptoms to look out for, visit the NHS website.
If you or a loved one have suffered a pressure ulcer, no matter how minor, please contact our Clinical Negligence team on 01633 244 233 within 3 years of the ulcer developing, and we will help you obtain the compensation that you deserve.