Imagine spending £186 million every year on something that you don’t need. Well, that’s what the NHS is doing. According to statistics provided by NHS England in 2013, it costs approximately £25,000 to treat every person with serious pressure ulcers. Around 80% of serious pressure ulcers are found to be completely preventable.
So why do these injuries still happen so often and when does it become so bad that a claim for compensation should be made?
What is a pressure ulcer?
A pressure ulcer, also referred to as a pressure sore or bed sore, is damage to the skin and tissue underneath. This happens when pressure is placed on the skin for a considerable amount of time, restricting blood supply. Essentially the skin breaks down, and the injury becomes deeper the longer it’s left untreated.
Who is at risk?
Anyone can suffer a pressure ulcer, however people who have restricted mobility are most at risk. For example, if you’re in a wheelchair or have to spend a long period of time lying or sitting, you are particularly vulnerable. The elderly are also particularly prone because their skin becomes more fragile with age.
How bad can it be?
At its worst, a pressure ulcer can damage all layers of skin, leaving the patient’s bone or muscles exposed.
The extent of the damage can vary – from the skin being red and sore, to blistering, to actually breaking down and dying. Pressure ulcers are ranked in ‘grades’, 1 being the mildest injury to 4 more the most severe.
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- Grade 1: the skin is intact but discoloured, as if it were bruised. The skin may be hard or itchy
- Grade 2: the outer layer of the skin is damaged, and the injury will appear as an open wound or blister, with some discolouration around the affected
- Grade 3: there is damage and loss to all skin layers. This will appear like a deep and open wound
- Grade 4: there is extensive skin loss and the tissue begins to die. The damage will go down to the muscle, leaving the bones or tendons exposed.
What needs to be done?
It’s better to be safe than sorry, and prevention is key when it comes to pressure ulcer damage.
Patients need to be assessed to see if they are at risk of injury. Patients who are deemed high risk (those who are elderly, have limited mobility or a past history of pressure ulcers) need a care plan which should prevent these injuries.
If damage has already occurred, it’s important that medical staff spot the signs early and treat injuries effectively.
Tissue viability nurses are specialists and should be involved in the care of any patient who has suffered a pressure ulcer which is not healing or has become a grade 3.
The National Institute of Health and Care Excellence (NICE) have published guidelines on the prevention and management of pressure ulcers.
When can negligence occur?
- Patients are not appropriately assessed – when a patient goes to hospital or into a care home, they should undergo an assessment to check their skin for any pressure injuries and to see if they’re at risk of this. If this doesn’t happen, patients who are at higher risk don’t receive the care they need to prevent pressure ulcers. The right kind of assessment can prevent the injury occurring at all. Most serious ulcers, especially those that are grade 3 and 4, are preventable – there is no excuse for any patient suffering this type of injury.
- The damage is not spotted – pressure damage can start as a small bruise, but can quickly turn into a blister that cuts through the skin down to the bone. Staff, particularly nurses who are around patients often, need to trained to detect any injuries whilst they’re still minor;
- Injuries are not treated correctly – the treatment required depends on the severity of the ulcer, however this can include moving the patient’s position, to allow blood circulation, using a special mattress and dressing any wounds to protect the skin. In more severe cases, surgery may be needed to remove infected areas
- The correct people are not notified – if a patient suffers a pressure ulcer in hospital or in a care home, their GP and consultant, if they have one, should be told. A tissue viability nurse, who specialises in skin and tissue, should be involved in treatment if the damage is not healing or has reached a grade 3.
I have worked on many cases where patients have suffered pressure ulcers due to medical negligence. These injuries cause the patients a lot of pain and suffering, and often prolong their stay in hospital or a care home. I recently won compensation for a client whose mother had suffered horrific pressure ulcer damage, starting at a grade 1 and over a few months becoming a grade 4 and gangrenous. This is an issue of public safety. We also cannot ignore this huge strain on the NHS.