Pressure sore negligence claims

Pressure sores, sometimes called pressure ulcers or bed sores, develop when pressure on the skin in an area of the body reduces the blood and oxygen flow to the skin and tissues, causing the layers of skin and tissues to break down.

People of any age can be affected by pressure ulcers, but those with poor mobility who have to spend long periods of time in bed or seated in a chair are at greater risk of developing pressure sores.

Patients who are immobile whilst in hospital can develop pressure ulcers on pressure points, such as their sacrum (base of spine), or their heels which are under continuous pressure from the weight of their legs and feet when they are left in one position for a prolonged period of time.

The risk of developing a pressure ulcer is increased by:

• lack of mobility or where the patient is unable to change their position;
• dehydration and poor nutrition, which affects the body’s ability to maintain healthy skin;
• older age, when the skin is fragile and new skin cells take longer to form;
• lack of sensory perception, such as after spinal cord injury, surgery or coma, when the patient cannot feel pain or the need to change position;
• after severe weight loss;
• urinary or faecal incontinence, as moist skin breaks down more easily;
• medical conditions affecting the circulation and blood flow to the skin.

Patients who are immobile or unable to turn themselves in bed, such as after surgery, must be nursed carefully to avoid tissue damage from pressure sores.

Most pressure sore compensation claims arise from failings in basic nursing care of patients who are at risk of developing pressure ulcers and bed sores.

Common mistakes which lead to pressure sore medical negligence compensation claims include:

• failing to assess properly, identify and chart the patient’s risk of pressure sores;
• failing to observe and note changes in the patient’s skin colour;
• failing to recognise early signs of pressure sores, such as redness on heels, elbows, sacrum;
• failing to record and classify the patient’s pressure sore in their medical records;
• failing to relieve pressure on sensitive areas regularly;
• failing to turn the patient regularly or nurse them on a pressure relieving mattress;
• failing to follow NICE guidelines on the prevention and treatment of pressure sores;
• delays in surgical, anti-infection and other essential treatment.

Occasionally, despite a high level of nursing care, some patients will still develop pressure sores due to irreversible tissue hypoxia (lack of oxygen). However, in our experience, most of our clients developed pressure sores in situations where they could have been prevented with an acceptable standard of care.

In most cases, where the patient receives correct nursing care, pressure ulcers or bed sores can be prevented. The most important way to prevent pressure sores is to avoid prolonged periods of pressure on any one area of the skin by encouraging the patient to change their position regularly throughout the day. People who cannot reposition themselves should be moved at regular intervals, and at least every two hours for those lying down and every hour for those sitting upright. Pressure relieving mattresses should be provided, and skin should be kept healthy, clean, and dry. Regular inspection of high-risk areas is important to detect and treat early signs that a pressure ulcer is developing. The first sign that a pressure sore might be forming is usually a change in the colour of the skin.

Some pressure sores can be treated successfully by relieving the pressure on the affected parts of the body using equipment like a pressure-relieving overlay system mattress, and by cleaning the affected area regularly and applying an appropriate dressing. The wound should be kept clean and moist and the area around it clean and dry. As a pressure sore heals, it will slowly get smaller. Less fluid will drain from it and new healthy skin starts growing at the bottom of the sore. It is essential is that the sores do not become infected. For more severe pressure sores, surgical debridement may be necessary to remove necrotic (dead) or infected tissue from the wound. In very severe cases, skin grafts, cosmetic surgery or maggot therapy may be necessary.

The healing process can take a long time and often requires ongoing treatment by district nurses or tissue viability nurses, who specialise in treating persistent ulcers.

Serious pressure sores can be very painful and difficult to heal, as the wound has to heal from the inside out. Depending on the affected area, severe pressure sores leave the patient with unsightly scarring from the wound and its surgical treatment, and can cause permanent difficulty with walking or sitting, as the skin becomes tight and is vulnerable to breaking down.

Any delay or failure to recognise and treat pressure sores can lead to significant worsening of the ulcer as the necrotic tissue extends across a larger surface area and into the bone. This can lead to disability from amputations and life-threatening infection, such as cellulitis or sepsis.