Pressure sore negligence solicitors

Pressure sores as a result of medical negligence are, unfortunately, all too common.

Pressure sores, also known as bed sores and pressure ulcers, are quick to develop but can take a long time to heal. They can be debilitating, extremely painful and, if left untreated, could be fatal. However, with proper nursing care they can also be prevented.

 

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Causes of pressure sores

Pressure sores occur as a direct result of unrelieved pressure and distortion of the skin and underlying tissue.

The extra pressure disrupts the flow of blood through to the skin and, without adequate blood flow, the area of skin becomes starved of oxygen and nutrients. The skin can then begin to break down and an ulcer forms.

People with health conditions which limit their mobility are most at risk of developing pressure sores. The elderly can often be at risk of developing sores due to a lack of mobility, and so pressure sores occur in care homes as well as in hospital.

Grades of pressure sores

Pressure sores are divided into four different grades, depending on the severity of the sore:

  • Grade 1: Discolouration of the skin.
  • Grade 2: Partial thickness skin loss, presents like a blister.
  • Grade 3: Full thickness skin loss, but damage of subcutaneous tissue, presents like a deep crater.
  • Grade 4: Full thickness skin loss with extensive necrosis extending to the underlying tissue.

Prevention of pressure sores

Pressure sores can be easily prevented through good nursing care. Every patient who has or is going to have reduced mobility should undergo an assessment, whether in hospital or a care home.

Pressure sore treatment

By risk assessing patients then putting in place appropriate care plans the risk of pressure sores developing is reduced, and could mean that they do not develop at all.

It should be realised that sometimes (despite a high level of nursing care) some patients will still develop pressure sores due to irreversible tissue hypoxia (where the tissue is deprived of adequate oxygen). However, in our experience, most of our clients have developed pressure sores in situations where they could have been prevented.

Once a pressure sore has been identified, a further assessment of the patient should be undertaken, and a revised repositioning plan put into place to avoid the sore worsening.

Pressure sore FAQs

Q. What is a pressure sore?

A. A pressure sore or bed sore is an area of damaged skin that becomes an open wound.

Q. What causes a pressure sore?

A. Pressure sores begin when the weight of your body presses down on the skin beneath you. Your blood cannot circulate properly to that area, and so skin cells break down and die.

The best way to describe how a pressure sore develops is to look at what happens to an orange in a fruit bowl which is not moved for a long period of time. The part of the orange in contact with the fruit bowl (i.e. where the pressure is) becomes mouldy and starts to decay. The same happens with the human body.

Q. Who can get a pressure sore?

A. People of any age can be affected by bed sores or pressure ulcers . In particular, people with poor mobility who have to spend long periods of time in bed or sat in a chair are at greater risk of a sore developing. People who are unable to change their position are also at higher risk.

Pressure sores often affect patients in hospital but can also affect people who live in care homes.

Pressure sores can also develop as a result of poor nutrition, anaemia, recurrent infection and poor circulation.

There is a tendency to assume that pressure sores are the inevitable result of prolonged bed-rest. This is not necessarily the case.

Q. How do I spot a pressure sore?

A. The first sign that a pressure sore might be forming is a change in the colour of the skin. This can then get progressively worse and can lead to an open wound.

Q. Where do pressure sores occur?

A. The most common places for pressure sores are over the bones that are close to the skin, like the bottom, heel, elbow, ankle, shoulder, back and back of the ear.

Q. Are there risk factors associated with pressure sores?

A. There are a number of risk factors associated with pressure or bed sores, such as:

  • Lack of mobility/inability to reposition – could lead to excessive pressure in one location.
  • Dehydration and poor nutrition – can affect the body’s ability to maintain healthy skin and prevent breakdown of skin tissue.
  • Age – as people get older, the skin becomes more fragile and new skin cells take longer to form.
  • Lack of sensory perception – people in a coma or suffering from a serious spinal injury may not be able to feel pain as a sore develops, and they are not therefore aware of the need to change position.
  • Weight loss – significant weight loss can result in less cushioning between the bone and for example, a bed, making it more likely a sore will develop.
  • Urinary/faecal incontinence – the skin is more moist, causing it to break down more easily.
  • Medical conditions affecting circulation – can cause the same issues as being unable to reposition yourself regularly, as the circulation to the skin is affected.

Q. What is a Waterlow assessment?

A. This is a risk assessment tool, used by nurses/carers to assess which patients are most likely to develop a pressure sore or ulcer.

Simply, the person undertaking the assessment reviews a chart that details all of the factors that might contribute to a pressure sore developing (e.g. build, weight, height, continence, mobility and whether someone has undergone major surgery recently).

Each factor is awarded a numerical value depending on the relevance of the risk factor and, once a final score is calculated, it is supposed to reflect the degree of risk the patient has of developing a pressure ulcer. It was developed in 1987 by Judy Waterlow, and is used throughout hospitals and nursing homes.

Q. Can bed sores be prevented?

A. In most cases, the answer is yes. The most important factor in preventing sores is to avoid prolonged periods of pressure on any one area of the skin. This can be achieved by encouraging a person 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.

Special air filled alternating pressure mattresses and cushions that redistribute pressure help reduce pressure on sensitive areas.

Regular inspection of high risk pressure areas is important to detect early signs and prompt medical care should be provided.

It is also important to keep skin healthy, clean and dry.

Q. What are the NICE guidelines relating to pressure sores?

A. NICE is the National Institute of Clinical Excellence.

In 2005, NICE issued guidance on the prevention and treatment of pressure sores, following a collaborative review with the Royal College of Nursing. The guideline gives guidance on the management of pressure sores in both primary and secondary care.

The key priorities identified in the guidance are:

  1. Patient should have an initial & ongoing risk assessment within the first 6 hours of care;
  2. The ulcer grade should be recorded using the standard classification system;
  3. There should be an initial and an ongoing pressure ulcer assessment, supported by photos and diagrams if appropriate;
  4. People vulnerable to pressure ulcers should be placed on a high spec foam theatre mattress;
  5. If a patient is having surgery, they should as a minimum be placed on a foam mattress;
  6. For Grade 1-2 ulcers, patient must be placed on a pressure reducing mattress and closely observed for skin changes;
  7. For Grade 3-4 ulcers, patient must be placed on a foam mattress with an alternating pressure relieving overlay or be placed on a continuous low pressure system.

Q. How can you tell if a pressure sore is healing?

A. 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. This new skin is light red or pink and looks lumpy and shiny.

Q. How do you treat a pressure sore?

A. It is essential is that the sores do not become infected.

For those who suffer less severe pressure sores, they can be successfully treated by trying to relieve the pressure on them using equipment like a pressure relieving overlay system mattress, 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.

For more serious pressure sores a procedure called debridement , where dead tissue and other materials are removed from the wound, may be necessary.

In even more severe cases skin grafts, cosmetic surgery or maggot therapy may be necessary. Maggot therapy is a carefully controlled practice whereby a medical professional will try and use maggots to break down and ingest infected or necrotic tissue. As well as getting rid of the infected tissue the maggots also disinfect the wound by killing bacteria and can stimulate wound healing.

Q. What are the consequences of pressure sores?

A. Serious pressure sores can be very painful and difficult to heal as the wound has to heal from the inside out. Heels are particularly vulnerable to pressure sores and the sores can cause permanent difficulty with walking as the skin becomes tight and is vulnerable to breaking down.

If there is a failure to recognise and treat the most serious of pressure sores, the necrotic tissue can extend over a larger surface area, and can invade the bone. This in turn can lead to amputation of the affected area.

The healing process can take a significant period of time, and often requires ongoing treatment by district nurses or tissue viability nurses, who specialise in treating ongoing sores.

The healing process is complicated by the cause of the sore, a lack of mobility, and so a carefully planned care regime which involves regular turning and repositioning, is crucial to aid recovery.

Q. Can I bring a claim for medical negligence as a result of sustaining a pressure ulcer?

A. If you or a family member or friend has suffered with a bed sore as a result of a medical professional failing to prevent a pressure sore developing, it may be possible to bring a claim.

Pressure sore definitions

The medical language associated with pressure sores can be complicated and difficult to understand. We have identified some of the key terms in use every day in relation to pressure sores.

A

Amputation

Amputation  is the surgical removal of a body part and can occur in the most extreme cases involving pressure sore negligence.

B

Bed sore

A  bed sore  is a change to an area of the skin caused by unrelieved pressure on soft tissues over a particularly bony area; otherwise known as pressure sores or pressure ulcers.

Bone infection

Bone infection  refers to when bacteria invade the bone and can often happen if the area is exposed to the outside environment.

C

Care home

A  care home  is an establishment that provides accommodation together with nursing care or personal care for persons who are or have been ill, have or have had a mental disorder, are disabled or infirm, or are or have been dependant on alcohol or drugs – Care Standards Act 2000.

Cellulitis

Cellulitis  is a common skin infection caused by bacteria. One of the common symptoms of cellulitis is skin inflammation or redness.

Claim

A medical negligence  claim  for compensation can be brought if you or a loved one has sustained a pressure sore as a result of negligent care.

Compensation is awarded if you can show that negligent nursing care, either in hospital or in a care home, has resulted in a pressure sore developing or becoming worse. The amount of the award depends on the severity of the injury.

D

Debridement

Debridement  is the removal of dead tissue from an infected area. Debridement may also refer to ‘surgical debridement’ which is the removal of tissue by surgery, or ‘chemical debridement’ which is the removal of the necrotic tissue by using certain enzymes.

Dehydration

Dehydration  is when the body does not have enough water or as much fluid as it should.

F

Friction

Friction  is the resistance to motion in a parallel direction. The occurrence of friction is an important consideration when assessing whether someone is likely to develop a pressure sore.

G

Gangrene

Gangrene  is the death of tissue in part of the body.

Grades of pressure sores

Grades of pressure sores  refers to the grading system used to diagnose pressure sore severity, these are:

  • Grade 1: Discolouration of the skin.
  • Grade 2: Partial thickness skin loss, presents like a blister.
  • Grade 3: Full thickness skin loss, but damage of the third layer of skin, presents like a deep crater.
  • Grade 4: Full thickness skin loss with extensive necrosis extending to the underlying tissue.

M

Maggot therapy

Maggot therapy  is an alternative method of  debridement . The maggots are mixed into the wound, and the area covered with gauze. The maggots eat the dead tissue but leave the healthy tissue intact.

N

Necrosis

Death of cells or body tissue through injury or disease; dead tissue.

NICE

NICE  is an acronym for the National Institute for Health and Clinical Excellence.

The standards laid out by NICE in their pressure sore guidance help healthcare professionals to understand what high quality care of pressure sores should look like. NICE have published specific guidance on the management of pressure ulcers in primary and secondary care.

P

Pressure

Pressure  is a force per unit area. This is another important consideration (along with friction) in assessing whether someone is at risk of developing a pressure sore.

Pressure redistribution

Pressure redistribution  surfaces seek to reduce the body's pressure over one particular area. Pressure redistribution surfaces include specialist foam mattresses or an air mattress.

Pressure relieving overlay system

pressure relieving overlay system  is a mattress made up of a number of cells that are pumped full of air. The cells sequentially inflate and deflate to gently alternate the surface interface pressure.

The moving air flow means a patient's weight is distributed differently as the cycle of air flow continues, avoiding the concentration of pressure over one area, which can result in a pressure sore developing.

R

Risk assessment

risk assessment  is an evaluation of the risks to a patient during their stay either in hospital or in a care home.

In respect of pressure sores, it is acknowledged in both the NICE Guidelines and the Health and Social Care Act 2008 Regulations 2010, that a patient or "service user" in the case of care homes, should undergo an assessment at the time of admission and the assessment should be ongoing to assess any changes.

S

Sacral pressure sore

A  sacral pressure sore  is an ulcer that develops over the sacrum, the triangular bone at the base of the spine.

Surface interface pressure

The  surface interface pressure  is the pressure exerted over the point where a body meets a mattress.

T

Tissue viability nurse

A  tissue viability nurse  is a specially trained nurse who offers advice and support in complex wound management.

W

Waterlow assessment

The  waterflow assessment  is a risk assessment tool that is used to assess each individual on arrival at hospital or a care home, to categorise the risk of them suffering a pressure sore or, if they already have an ulcer or possibly the beginning of a sore, the risk of making a pressure sore worse.

This can then lead to more specific treatment, like the use of a pressure reducing mattress to try to avoid a sore developing or getting worse.

Wound documentation

Wound documentation  is a detailed description of a wound, including the location, size, health of surrounding tissues, signs of infection, and often outlines the proposed care and treatment plan.

Wound vac or vac pump

A  wound vac or vac pump  is a machine that uses negative pressure to help heal an open wound and draws out fluid, increasing blood flow to the area.

I am overwhelmed by the outcome in terms of the monetary value and know I should consider it as a near a 'sorry' as I am likely to get from the hospital. It will be nice to start the process of closure on the whole issue now and look towards the future for us as a family. 

Mrs T, Surrey 

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