We often come across scenarios of medical negligence that could have been avoided, and pressure sores are no exception. With risk assessments involved at an early stage of hospitalisation for all patients (more on this below), there are certainly precautions that must be taken and that are outlined in the National Institute for Health and Care Excellence (NICE) guidelines.
In my article below I discuss pressure sores in more detail, the different categories and the precautions that must be taken for any patients at risk. If you or a loved one have developed a pressure sore – or an existing sore has deteriorated due to medical negligence, our team may be able to help.
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What are pressure sores?
Pressure sores (also known as bedsores or pressure ulcers) are damage to a particular area of skin or underlying tissue following a prolonged period of immobility where there is unrelieved pressure. They usually form as a lesion or wound and can present quite quickly depending on the individual, amount of pressure applied, and/or the type of equipment someone is on.
Who are the most susceptible to pressure sores?
All patients are at risk, but most likely to develop a pressure sore are those who have a serious illness or injury, have history of pressure damage, have mobility or nutritional impairments and where there is moisture to the skin e.g. when incontinent.
What are the categories of pressure damage (European Pressure Ulcer Advisory Panel 2019)?
Category 1
Non-blanchable erythema: when the skin is not broken but requires monitoring and care. The skin appears reddened, even when no pressure has been applied. The skin will usually feel warmer and harder than the surrounding skin. It may also be more sensitive to pain.
Category 2
Involves partial-thickness skin loss. This means that the top layers of the skin are damaged. The skin may resemble a superficial blister or abrasion.
Category 3
Characterised by full-thickness skin loss. This is because all of the skin’s layers are damaged, and the wound extends into the subcutaneous tissue. The wound may be covered in slough (dead skin and pus) and there may be the presence of necrotic tissue (dead skin).
Category 4
Occurs when the wound and surrounding skin have sustained extensive damage, with much of it becoming necrotic. The muscles, tendons and bones may also have significant damage. The wound is usually either covered in slough or has begun to scab. Exposed bone/tendon is visible or directly palpable.
Deep Tissue Injury
Depth unknown. Purple or maroon localised area of discoloured intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.
Unstageable
Depth unknown. Full thickness tissue loss in which the base of the ulcer is covered by slough. (Yellow, tan, grey, green, or brown) and/or eschar (tan, brown or black) in the wound bed.
What precautions are in place to protect an individual against the development of a pressure sore?
All individuals should have a pressure sore risk assessment when being admitted to hospital, and this should take place within at least 6 hours according to the NICE guidelines.
The pressure sore risk assessment tool takes into account multiple risk factors including past medical history, sex, age, nutritional status, continence, mobility, and current skin status. It should also be used in conjunction with clinical judgement.
Following assessment an individual will be scored low risk, high risk, or very high risk. It is important to be accurately scored as failure to do so could mean that inadequate measures are put in place to guard against new or existing pressure damage.
What can be done to guard against developing or deteriorating pressure sores?
For those most at risk of developing pressure sores, preventative measures should be put in place. These include but are not limited to: –
- Implementing a repositioning regime e.g. 2 or 4 hourly turns;
- Daily skin inspections;
- Providing a dynamic mattress or lateral turning device;
- Providing a special cushion;
- Referral to the Tissue Viability Nurse Team.
What is the impact of pressure sore damage?
The short-term impact includes increased pain and discomfort, periods of immobility, delayed recovery of unrelated medical conditions, increased risk of infection, bleeding and wound leakage, and in the most severe cases the need to undergo a wound debridement procedure (where the wound is fully cleaned and any skin/tissue that is damaged is removed).
The long-term impact includes scarring, permanent skin sensitivity and reduced skin strength in the damaged area, joint issues, and increased risk of future pressure damage in the same area.
In most cases, pressure sores are almost always avoidable, particularly those graded category 3-4 or where there are multiple sores and this could be a strong indicator of medical negligence.
