Pressure ulcers can develop in a matter of hours and all care staff need to be constantly vigilant.
Current nursing practice guidelines should make the development of pressure sores an extremely rare occurrence. The following simple measures should be implemented as a bare minimum:
- Carry out a clinical risk assessment on admission
- Reposition the patient, this may be 3-4 hourly in a patient with mobility and an understanding of the need for frequent self-repositioning; reducing to 1-2 hourly in patients with very compromised mobility, health or comprehension. Skin inspection should take place with similar frequency.
- Provision of pressure relieving support surfaces such as beds, mattresses, overlays or cushions
- Ensure that the nutritional status of the patient is maintained and the risk of infection is reduced.
If these are followed then in the vast majority of cases, pressure sore development can be avoided. However, if a patient either develops sores, or is admitted with sores, the following additional measures should be taken:
- Ensure medical and or surgical staff are involved for treatment
- Ensure a specialist nurse (such as a tissue viability nurse) is called upon for advice and treatment in a timely manner
- Clinical records in the form of daily monitoring of the pressure sores and the care are maintainedI have received a report today where all 7 of the above were completely disregarded. Moreover the defendant twice discharged the patient to community nurses with Grade 4 pressure sores when the district nurse service could not possibly have the resources to effectively treat such severe pressure sores. As a consequence her sores became considerably worse.
Tragically this patient died in a nursing home. The post-mortem states the cause of death as Septicaemia from infected pressure sores. I am very confident that I will recover compensation for this lady's family; but this will be scant recompense for the knowledge that had she been appropriately treated and not developed the sores, the potential for her being discharged home in good order would have been exceedingly good.
Iona Meeres-Young is a Clinical Negligence Solicitor at Slater and Gordon Lawyers in London.
If you or a loved one developed pressure sores in hospital or in community care, call Slater and Gordon for a free consultation on freephone 0800 916 9049 or contact us online and we'll be happy to help.
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