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Clinical Negligence Specialist Paul Sankey on whether Pressure Sores can be avoided
The answer is that in the vast majority of Pressure Sore Claims can and should be avoided with proper nursing care. It is therefore frustrating to be approached regularly by clients who have suffered quite severe pain and in some cases even Amputations after developing Pressure Sores in hospital.
The NHS has taken a number of initiatives in the past to avoid Pressure Sores and guidance in 1994-95 aimed to reduce them by 5% annually. One document by the NHS Executive is called ‘Pressure Ulcers – A Preventable Problem’. The clue is in the title. They are preventable. One Tissue Viability Nurse wrote in 2001, ‘It is a sad indictment to the current state of care in the UK that the government feels it necessary to set out a national framework for the prevention of pressure related damage’. It is a sad indictment because at one time levels of nursing care were such that Pressure Sores were rare. This is not necessarily to criticise nurses – staffing levels on wards are sometimes such that patients receive too little care.
Generally hospitals should identify patients at risk of pressure damage and assess them using a measure such as the Waterlow Scale. Patients at greater risk should be placed on pressure-relieving mattresses. If there is a particular area at risk – for instance heels in a patient who keeps sliding down the bed – there may be other appropriate equipment to assist. Their skin should be inspected regularly and some patients should be moved or turned regularly. There is no rule as to how frequently. There is a disadvantage in moving them too frequently and disturbing their sleep. What is right for a patient depends on the condition of their skin and the level of risk. Adequate nutrition is important: malnourished patients are at greater risk. If any blemishes develop they should be properly monitored and their condition recorded. Where Pressure Sores develop the patient should be seen by a Tissue Viability Nurse. However the key is prevention rather than treatment.
Pressure Sores are bound to cause pain. In some cases they may resolve relatively quickly. However we have dealt with claims for people who have suffered Amputations or died. In one of the worst cases an elderly man had to undergo an above-knee Amputation of one leg because of Pressure Sores. Had he not then tragically died from infection he would have needed a second above-knee Amputation. This is therefore a very serious problem.
None of this is rocket science. It is disappointing therefore that Pressure Sore Claims form such a large part of our practice. Pressure Sores generally can be prevented and, with proper care, they should be.