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Pressure Sores: are they avoidable?


    Rebecca Callard considers the ongoing problems with pressure sores for patients in hospital and whether they always develop through inadequate care.

    By Rebecca Callard

I was interested to read in the news recently about an initiative at an NHS Trust in Coventry aimed at preventing patients from developing pressure sores.  The Trust have purchased a new teaching doll called “Sally Sore” to raise awareness of the risks of pressure sores to patients admitted to the hospital, to provide practical demonstrations of preventative measures and to highlight the importance of record keeping.  Sally Sore even has her own twitter page to communicate information and practical tips on pressure sore prevention.

This is a positive step, and one hopefully that will prove beneficial for patients under the care of that NHS Trust. Unfortunately, as a clinical negligence lawyer my experience is that patients are still suffering from these injuries and sometimes due to basic omissions in their care.

What is a pressure sore?

In brief, a pressure sore or pressure ulcer is an area of skin which is damaged due to a person staying in 1 position for a period of time; either as a result of a large amount of pressure being focussed on 1 area for a short amount of time, or alternatively, a small amount of pressure over an extended period of time.

Why do hospital patients develop pressure sores?

Pressure sores commonly develop when a person is in hospital because they are often at this time bedbound or spending much less time being mobile.

Areas which are most at risk of the development of a pressure sore are where bones are close to the skin such as the heels, ankles, elbows and hips, but they can also commonly occur on the buttocks where a lot of pressure is applied when, for instance, a person is sat up or laid in bed for long periods of time.

Those people who are most at risk of suffering a pressure sore include those with impaired mobility, those who are clinically obese, those with ageing skin (so elderly people), where there is already a damaged area of skin, and anyone with a pre-existing medical condition, particularly affecting the blood, such as diabetes.

How severe is a pressure sore?

This type of injury can range in severity and are graded as such from 1-4, 4 being the most severe.  They can range from a small bruise or blister to a deep open wound that requires daily dressing and treatment.  In more serious cases, pressure sores can develop life-threatening complications such as blood poisoning and gangrene and this may lead to the need for surgical intervention.  Either way, pressure sores can be upsetting and challenging to treat, and can often lead to a patient requiring an extended hospital admission than they otherwise would have done for their original need.

How can pressure sores be prevented?

It is vital that when in hospital each person is assessed as to their risk of developing a pressure sore, and then that specific preventative measures are put in place to avoid the injury from occurring wherever possible.  Ways to prevent pressure sores from developing include pressure-relieving aids and equipment (special mattresses or seat cushions etc) and regularly changing position.  Sometimes, if a person is not able to change position for themselves then they will require assistance with this, either from a nurse or a carer for example.

Can they develop even with good nursing or hospital care?

Even with adequate nursing care, pressure sores can develop and it is not always possible to prevent them.  However, there are still occasions where inadequate care leads to the development of pressure sores where they could have otherwise been avoided or steps taken to prevent the injury becoming more severe.

I and my colleagues continue to act for a number of patients who have suffered pressure sores and the issues usually involve either failures to undertake proper assessment of the patient for their risk of pressure sores, or failures to implement preventative measures after a risk has been identified.  In such circumstances the pressure sores usually absolutely could and should have been avoided but for these admissions.

Unfortunately for patients who suffer pressure sores during their hospital admission  it is then sometimes the case that the development of secondary complications can have a negative impact on an overall clinical outcome for the patient from their original condition.  If the pressure sore should have been avoided then the patient is entitled to financial compensation for their additional pain and suffering.

I hope that the ongoing and more widespread use of initiatives such as “Sally Sore” will continue to raise awareness and improve patient care so that the avoidable pressure sores are avoided.

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