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What is a pressure sore and why is it important to continue the battle to prevent patients suffering these complications.
I was pleased to read recently about how a local hospital had utilised the humble gingerbread man to tackle the ongoing battle with prevention of pressure sores amongst their patients. The gingerbread man is iced to highlight to staff the most vulnerable areas of skin and remind of the need for good skin care to prevent these sores which can have devastating effects for patients.
Pressure sores can occur when patients are placed in one position for long periods of time, without proper nursing care and/or proper equipment to manage this risk. Whilst any patient group may be affected by pressure sores, particular groups including diabetics, the elderly and bariatric patients will be at greater risk, whether as a consequence of a limited movement capacity or poor peripheral blood supply.
Pressure sores are extremely unpleasant. If left untreated, they can cause serious complications.
Using the standard NPUAP (American National Pressure Ulcer Advisory Panel) – EPUAP (European Pressure Ulcer Advisory Panel) classification system, 4 grades of pressure sore are described, as follows:
1. (the least serious stage) – intact skin, possibly discoloured. If pressure is applied to it, the skin in the affected area will not go white. The area will usually sit over a prominence of bone. There may be darkly pigmented skin. The area may be harder, painful, softer, warmer or cooler compared to tissue next to it. It can be harder to detect in persons with darker skin tones.
2. Partial thickness skin loss or blister. There may be a shallow open ulcer with a red or pink wound bed, without slough (dead tissue). The presentation may also include an intact or open blister.
3. Full thickness skin loss – the entirety of the skin tissue will be absent, and subcutaneous fat (this looks yellow) may be visible. Bone, tendon or muscle will not be exposed. Some dead tissue may be present.
4. Full thickness tissue loss – the tissue loss is extensive enough for bone, tendon or muscle to be present.
There are national guidelines for the prevention of pressure sores, but my experience is that adherence to these has historically been patchy. There may also have been underreporting of this problem, as some organisations only recorded grades 3 and 4 pressure sores rather than also grades 1 and 2. The existence of a live issue for the NHS was tacitly acknowledged in 2009 by the Department of Health’s publication of a position statement on what constituted avoidable and unavoidable pressure sores:
“ ‘Avoidable’ means that the person receiving care developed a pressure ulcer and the provider of care did not do one of the following: evaluate the person’s clinical condition and pressure ulcer risks; plan and implement interventions that are consistent with the person’s needs and goals, and recognised standards of practice; monitor and evaluate the impact of the interventions; or revise the interventions as appropriate.”
Poor education as to the prevention of pressure sores is a known risk factor; conversely, prevention of pressure sores should be a keystone of good nursing care. Sadly, whilst efforts have been made to address this problem, such as the use of the gingerbread man, there are still many cases emerging and therefore clear that much more work and effort is required.
As a firm of medical negligence solicitors, we have handled many cases involving pressure sores , ranging from relatively minor injuries to very sad cases in which the consequences of failure to treat the patient adequately were catastrophic. We hope to see hospitals developing other such unique ideas and methods for improving education and patient care going forward.