2020-08-12
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Medical negligence; pressure sores

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Posted by Rachael Flanagan on 11 August 2020

Pressure sores are painful debilitating injuries which should not occur if you or your loved one is being cared for and nursed in the most supportive way.

What is a pressure ulcer/ pressure sore?

Pressure ulcers (more commonly referred to as pressure sores or bed sores) are areas of localised damage to the skin and tissue. They largely occur as a result of prolonged pressure or friction on the skin and usually affect those with limited mobility or those who are confined to a chair, bed or wheelchair for prolonged periods of time. They are painful and often debilitating.

Where do they occur?

They affect any part of the body where pressure is placed and are most common over bony prominences such as the elbows, sacrum (base of the spine), heels, shoulder blades, hips and behind the knees.

How do they occur?

They occur when a patient is in contact with a surface or in the same position for a long period of time, usually because they are unable to move their weight to an alternate position. They can also be caused as a result of friction and moisture. This pressure or friction disrupts blood flow to the area and the skin becomes deprived of oxygen causing the skin to break down, which can then lead to an ulcer.

They can develop very quickly and whilst they can develop even with high levels of care, in our experience pressure sores are often preventable and should not occur.

How is a pressure sore treated?

The longer the pressure sore is left untreated the worse it is likely to become. Early identification and treatment is vital to prevent more serious complications such as infection, sepsis, cellulitis or skin necrosis (death of the skin cells).

Prevention is key as pressure sores can be difficult to treat. It is important to relieve or reduce pressure in one area for patients who are confined. Changing a patient’s position during the day and night will help prevent a sore. Sometimes a specialist mattress (or air flow mattress) is beneficial as this can help reduce or remove pressure from one area.

A patient’s skin should be checked on a daily basis for early signs of redness or discolouration. Practising good daily skin care is important as pressure sores are more likely to occur if the skin is too dry or too moist. If you are in a care home or hospital setting, your skin check should be documented on a daily basis

If a pressure sore does develop, symptoms include discolouration of the skin and pain in the early stages. The skin then breaks down and can cause an open wound or blister which, if left untreated, can reach down into underlying structures such as the muscle and bone. As well as being very painful, once the wound is open, it is particularly susceptible to infection so it is vital the wound is cleaned and dressed. Often a tissue viability nurse will be asked to attend patients who have more serious pressures sores to try and prevent further deterioration or surgery to remove damaged tissue and promote skin closure.

There are varying degrees of pressure sore and they are graded based on severity, with Grade 1 being the least severe and Grade 4 being the most severe.

  1. Grade 1 - discolouration of intact skin
  2. Grade 2 - some damage to the top layers of skin such as a blister
  3. Grade 3 - full thickness skin loss, skin necrosis and damage to underlying layers of skin
  4. Grade 4 - the most serious which includes skin necrosis and damage to underlying muscle and bones

Development of a pressure sore in a care home/ hospital setting

Care home providers and Hospitals have a duty to their patients to ensure measures are taken to prevent pressure sores forming or deteriorating.

Whilst sometimes pressure sores can develop even with high levels of care, in our experience from client’s we have represented, pressure sores are often preventable and should not occur in a care home or hospital setting if a patient is appropriately risk assessed and repositioned on a regular basis. If a pressure sore does develop, it should be identified quickly and treated so this does not develop into a more serious sore.

Every patient should be assessed on admission under the Waterlow pressure sore risk assessment which is a tool to identify the risk status or “Waterlow Score” of a patient for the development of a sore. Those who have a higher score are at a greater risk of pressure sores and often this will include the elderly or those who are immobile. A preventative care and nursing plan can then be developed for that patient which will identify measures to prevent or reduce the risk of a pressure sore developing such as how often the patient should be repositioned and in what positions. The assessment should be reviewed on a regular basis.

How can we help?

Medical negligence claims often arise from the failure to carry out appropriate risk assessments; poor or delayed treatment and poor record keeping.

If you or a loved one has suffered with a pressure sore whilst in a care home or Hospital setting, please get in contact with us to see how we might be able to help you.

About the author

Rachael is an experienced and dedicated specialist in the medical negligence and personal injury team. Rachael represents clients who have suffered serious and debilitating injuries.

Rachael Flanagan

Rachael is an experienced and dedicated specialist in the medical negligence and personal injury team. Rachael represents clients who have suffered serious and debilitating injuries.

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