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Why are there still too many cases of pressure sores in our hospitals and care homes?

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    Lucy Norton considers a recent Care Quality Commission report, and the number of potential cases seen by our clinical negligence team, regarding the development of pressure sores whilst an inpatient in either a hospital or care home.

    By Lucy Norton

As a clinical negligence solicitor I am often asked to investigate and bring claims for people who have developed pressure sores.  These have often occurred in hospital but are then treated in the community.  They can be disproportionately painful from the small blister or sore they may start with as they get worse or become infected.  Unfortunately, there have also been a lot of cases reported in the media recently relating to pressure sores developed by the elderly whilst being looked after in care homes and nursing homes.

What are pressure sores and what causes them?

Put very simply, and not intending to be a technical definition, pressure sores occur as a direct result of unrelieved pressure on the skin and underlying tissue.  The pressure causes a decrease in the flow of blood to the skin which then begins to break down.  I often use the analogy of leaving an orange in the fruit bowl for a long period of time.  To look at the orange without moving it, it still looks good.  However, if you pick the orange up, the part which was in contact with the fruit bowl has gone bad; in fact it has started to rot.  The same occurs with our bodies.

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.

In a worse case scenario, I have acted in a claim where the sore and necrosis became so extensive it resulted in a below knee amputation.  Fortunately most cases are not as serious as that but it does take some considerable time for pressure sores to heal and there can then be scarring.

Who is at risk of developing pressure sores?

Those at risk are people with health conditions which limit their mobility for a period of time.  The elderly are particularly vulnerable and at risk of developing sores due to a lack of mobility and fragile skin, so pressure sores can often occur in care homes as well as in hospital without appropriate care.  Anyone who is bedridden or immobile for a period of time should be nursed or treated in a way so as to relieve the pressure and prevent any breakdown of the skin occurring.

Pressure sores in care homes

As referred to above, there have been several cases in the media of families bringing claims as a result of poor care and neglect of their loved ones whilst they were residents of care homes.  There have been horrifying pictures of pressure sores which should simply not have occurred.

However, it was reported by the BBC recently that the Care Quality Commission (CQC) believe people in care homes in England are now safer and being looked after better than they were two years ago.  This is reported to be as a result of the CQC’s tougher inspection system and follow up.  The CQC went on to say that nearly three-quarters of 372 care homes rated inadequate in 2014 and still operating had improved. Of those, 205 had moved from an inadequate rating to requiring improvement, 68 were now rated good and 99 did not have their rating changed.  It is also probably good news that 34 homes which were rated inadequate in 2014 have since closed.

There are many factors to take into account as to why there are still so many cases of patients suffering pressure sores.  The NHS is often under pressure with not enough staff, however, with appropriate training of staff (in both care homes and hospitals) and proper risk assessments of patients, pressure sores are in the main entirely preventable and therefore more still needs to be done.

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