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Does the mere existence of a pressure sore infer negligent care?

Posted: 27/07/2017

Pressure ulcers - sometimes also called pressure sores, bed sores, pressure damage or decubitus ulcers - are extremely painful and cause severe harm to a patient. But what exactly are they?

A pressure ulcer is an area of localised damage to the skin and underlying tissue caused by pressure, shear, friction or a combination of these factors. The severity of a pressure sore is graded 1 to 4 (4 being the worst), to specify the level of tissue damage that a patient has experienced.  If a patient has a grade 3 or 4 ulcer, this means that significant tissue damage has occurred, to the extent that bone, tendon or muscle may be seen.

Pressure ulcers may also be identified as a ‘suspected deep tissue injury’, if the skin hasn’t broken down but tissue damage has been sustained underneath, or ungradeable, where there is too much dead tissue to see the extent of injury without cleaning out the wound. 

As a result of the tissue damage experienced, ulcers can be excruciatingly painful and debilitating. Of concern is that those at the greatest risk of developing pressure ulcers are often some of the most vulnerable members of society – patients who are unable to move independently or who suffer from a neurological condition, such as dementia. 

Not only are pressure ulcers extremely painful, but they also put a patient at risk of developing a number of complications, such as:

  • cellulitis
  • bacteraemia
  • bone and joint infection
  • necrotising faciitis
  • gas gangrene
  • sepsis
  • multi-organ failure
  • limb amputation
  • death

Since 2010, when it adopted a ‘zero tolerance approach to pressure ulcers’, the NHS has focused on reducing the number of pressure ulcers that develop. However, they remain a huge problem. Between April 2014 and March 2015, 25,000 patients developed a new pressure ulcer and on average 2,000 new pressure ulcers arise each month in patients under the care of the NHS. 

While pressure ulcers are clearly a very common occurrence, particularly in those over 70 years old, what is also clear is that small changes can make a very significant difference to outcomes – in the majority of cases pressure ulcers can be prevented if simple measures are followed.  Adjustments to basic nursing care, such as observing patients’ skin, changing the position of patients at regular intervals, making sure they are not exposed to unnecessary moisture (especially if they are incontinent) and monitoring their nutritional intake, have a considerable impact and notably reduce patients’ chances of developing a pressure ulcer.

Helen Hammond, a senior associate in Penningtons Manches’ clinical negligence team, based in the Basingstoke office, who specialises in dealing with cases relating to the development of pressure ulcers, comments: “It is worrying that we continue to see so many pressure ulcers occurring when, had a patient received appropriate basic nursing care, these would have been avoided.  We hope that the NHS continues to focus on the reduction of these extremely painful and distressing injuries, which so frequently are preventable if patients are correctly assessed and managed from the outset.”

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