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Pressure sore claims – a major drain on the NHS

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    Pressure sores are widely considered to be entirely preventable with appropriate nursing care yet there seems to be no reduction in the number of pressure sore claims against the NHS.

    By Kerstin Kubiak

Members of the Clinical Negligence Team recently secured a £10,000 interim payment for a patient who sustained grade four pressure sores while in Mid Staffordshire NHS Foundation Trust and University Hospital of North Staffordshire Foundation Trust hospitals. This is one example of the numerous cases we see each year where a patient has suffered an avoidable pressure sore while in hospital.

Nursing neglect

An apology and an admission of liability from both Trusts were made for the pressure sores sustained by a 65-year-old woman inpatient. Osteomyelitis, contractures and spasticity were also alleged to have been caused by poor nursing care while she was in their care, which together with her acute pressure sores, left her with additional injuries, in considerable pain.

This sub-standard care (over a prolonged period, bearing out the findings of the Mid Staffordshire Inquiry) led to grade four pressure sores, in some places open to the bone. As a result, the patient was bedbound to protect her skin from further breakdown and became a prisoner in her own home.

Incidents of pressure sores need to reduce

A lot of people think ‘bedsores’ are a trivial matter, yet they lead to serious disability and  avoidable deaths of frail and elderly patients every year.

Pressure sores are graded between 1 and 4 depending on their severity.  When an ulcer reaches Grade 4 the skin is severely damaged and there can also be damage to the underlying muscle and bone.  The patient is also at high risk of contracting an infection in the wound.  The ulcer needs careful care and can take months and sometimes years to heal, sometimes even requiring surgery.

These sores can occur when patients are in hospital for routine treatment from which they should have made a quick recovery.  The development of a pressure sore can therefore have a catastrophic effect on recovery from routine procedures and more must be done to prevent them.

The message still does not seem to be getting through to the medical and nursing professions that with a proper standard of basic care they are entirely preventable.  Our experience is that the biggest areas of failings relate to:

  1. The initial assessment of the patient – if the risk of pressure sores is not adequately assessed then appropriate preventative measures will not be taken.
  2. Providing appropriate equipment.  Often it is noted that a special bed mattress is required but then there is a delay in this being provided.  One or two days without such a mattress can make a big difference as pressure sores can develop quickly, particularly when a patient is deemed to be a high risk.

The Government announced that pressure ulcers were to be included in a long list of 60 outcome measures against which NHS hospitals will be judged to assess quality of care.  This alone is not sufficient and there needs to be greater awareness and training of medical staff of the risks and also importance of providing appropriate preventative care, together with appropriate resources to enable this care to be provided.

The outcome for a patient of suffering a pressure sore can be seriously disabling, with patients requiring care and suffering other financial losses.  Patients then instruct solicitors to make a clinical negligence claim against the hospital to compensate them for these losses.  As specialist medical negligence solicitors we have seen no reduction in the number of pressure sore claims over recent years and therefore more needs to be done to reduce the incidence of these preventable injuries.

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