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In the UK, we benefit from a high standard of nursing care, both for patients in hospital for extended periods and those living in care homes. However, it is an unfortunate truth that pressure sore claims are far from uncommon.
In a number of cases, pressure sores are a result of medical negligence, be that as a result of inadequate prevention measures or nursing care leading to a sore developing. There can also be a failure to spot and treat a pressure sore. While there are certain circumstances where the development of a pressure sore cannot be avoided, in most scenarios competent nursing care will prevent pressure sores from becoming an issue.
In this article, we will explore what pressure sores are; cover the causes, symptoms and potential complications; look at what steps healthcare professionals should take to minimise the risk of one developing and how you can claim for compensation following the development of a pressure sore or poor management of one.
What is a pressure sore?
Pressure sores – also referred to as pressure ulcers, bedsores or decubitus ulcers – occur when there is unrelieved pressure on the skin and underlying tissue for extended periods of time. This is often the result of prolonged pressure on areas of the body, typically those where a bone is in close proximity to the skin, such as:
- The sacrum, bottom or lower back
- The heels or ankles
- The elbows
- The shoulders
- The back of the ear
It was estimated by NHS Digital in 2017 that 1,300 cases of pressure ulcers were reported in NHS hospitals each month, demonstrating how prevalent these are in spite of the preventative measures established to minimise the risk of these forming.
There are 4 grades of pressure sores, with a Grade 1 pressure sore being the least harmful and Grade 4 representing the most high-risk.:
Pressure sore grading
- Grade 1: discolouration of the skin, which may feel warm, spongy or hard and causes a degree of pain or itchiness in the affected area
- Grade 2: partial skin loss, presenting as an open wound or blister
- Grade 3: a deeper wound that reaches deeper levels of the skin, presenting like a crater on the skin
- Grade 4: a very deep wound that may reach muscle or bone, potentially with extensive necrosis to the underlying tissue
While the majority of bedsores are identified at an early grade and so can be effectively managed and treated without any serious consequences, a Grade 3 or 4 pressure sore can lead to dangerous complications, which can often be the basis for a medical negligence claim.
What causes pressure sores?
The most prominent cause of pressure sores is a significant lack of mobility over a period of time. This can be due to a person being bed-bound or wheelchair-bound, during or in recovery from surgery, or simply by laying or sitting in the same position for a long time.
However, the stages of pressure sores are typically not time-related – it is due to how fragile or delicate the skin of the person in question is. This should be identified by a nurse who should carry out a Waterlow Risk Assessment. This is a chart which is completed to help determine which patients are at risk of developing pressure sores.
How can you spot pressure sores?
The first sign of a pressure sore is if the skin is discoloured. This will typically mean red patches for those with pale skin, and blue/purple patches for those with dark skin. If the discoloured patches do not turn white when pressure is applied to them, or then feel unusually warm, spongy or hard, that is an indication that it is a Grade 1 pressure sore.
Over time, there is the potential for the pressure sore to transition into an open wound. At this point, it is critical that it is examined by a medical professional, as it is now at risk of becoming infected.
What is the Waterlow Scale?
The Waterlow Scale was established by clinical nurse teacher Judith Waterlow in 1985. Within it is a scoring chart that nurses use to this day to identify if a patient under their care is more likely to develop pressure sores.
This chart scores each individual on the following factors:
- BMI (Body Mass Index)
- Skin type (e.g. overly dry skin, clamminess, signs of discolouring, etc.)
- Tissue malnutrition
- Neurological deficit
- Major surgery/trauma endured
- Cytotoxics (medication used to kill cells)
A score of under 10 indicates that the patient is low risk, and so a nurse would not be expected to implement special measures against them developing pressure sores. A score of 20+ places the patient as an extremely high-risk case, and would therefore need to be regularly monitored and moved to prevent this condition.
A failure to undertake the Waterlow Risk Assessment, or to not fulfil the care recommended by the patient’s score, can be the basis of a pressure sore claim.
As well as this assessment, NICE (The National Institute for Health & Care Excellence) also has published guidelines on the prevention and management of pressure ulcers. As expert clinical negligence solicitors, these guidelines help us assess whether a healthcare provider fulfilled their duty of care to their patient or if their actions (or inactions) would be considered negligent.
Who is likely to develop bedsores?
Pressure sores can affect anybody at any age, but there are a number of risk factors that make someone more susceptible to these:
- If someone is over 70 this can mean they are less mobile and their skin may be more prone to damage through dehydration and other factors
- If they are paralysed or are unable to move parts of their body
- If they are obese or malnourished
- If they have a poor diet
- If they are a smoker, as this hurts blood circulation
- If they suffer from urinary or bowel incontinence
- If they suffer from a condition that restricts blood flow around the body, makes the skin more fragile, or makes movement difficult (e.g. diabetes, heart problems, multiple sclerosis, Parkinson’s Disease, etc.)
How can pressure sores be prevented?
This is arguably the most crucial question, as in most cases pressure sores are entirely preventable when best nursing practices are applied. In most cases, best practice is followed and patients avoid developing bedsores.
Steps that a healthcare provider might take to reduce the risk of their patient developing pressure sores include:
- Regularly changing the position of or turning a patient, particularly if they are unable to do this themselves due to their condition
- Providing the patient with a pressure-relieving mattress, which is specially air-filled to relieve pressure on particular areas of the body – these can also be delivered to the patient’s home when they are discharged from the hospital
- Inflatable pressure-relief ring cushions for wheelchair users or people that would be sitting down for extended periods of time
- Regularly washing and drying the skin to keep it clean and healthy
- Ensuring the patient maintains a balanced diet and receives plenty of fluids
- Frequently checking and monitoring the patient’s skin (particularly in high-risk areas) to identify any pressure ulcers at an early stage
However, it is important to note that in some circumstances, despite the best nursing care available, sometimes a pressure sore will occur. If a patient suffers from irreversible tissue hypoxia, where the tissue is deprived of adequate oxygen, this will make them extremely susceptible to these even when the best possible care is delivered.
Furthermore, in instances where the risks of moving the patient outweigh those of developing bedsores, such as if they are systemically unwell, then a nurse may not necessarily be viewed as neglectful for pressure sores developing in these instances.
Nevertheless, through good nursing care, these conditions can often be avoided altogether, and therefore remove the risk of any harm coming to the patient or the need for a claim for pressure sores negligence.
How is a pressure sore treated once identified?
If a pressure sore has developed, treatment will depend on at what stage the problem was identified.
If the bedsore is spotted early, simply relieving the pressure and more attentive nursing care will prevent it from progressing into an open wound, and the discolouring will often fade away naturally over time. This might be through regularly repositioning the patient, or by providing them with special mattresses or pillows to relieve pressure in certain areas.
Dressings might also be used to protect pressure ulcers from further damage and to speed up the healing process. Alginate dressings, hydrocolloid dressings and hydrofibres are all options of what can be applied in these circumstances. The nurse should inform the patient of what they are using.
If the pressure has become an open wound, if it has become infected the patient should be prescribed antibiotics. In these more serious instances, debridement may be required. This is where dead tissue around the ulcer is removed to allow healthy tissue to heal.
An alternative form of debridement is maggot therapy. This is where maggots are mixed into the wound dressing for several days so they can eat the dead and infected tissues surrounding the pressure sore, while leaving all healthy tissue intact.
In severe cases where the wound is not expected to heal on its own, surgery may be necessary to seal the wound, prevent the risk of infection, and cover the scarring over with a skin graft. However, this option carries its own risks, as often the patient will not be in the best of health when the sore develops. As such, it is crucial that a surgeon informs their patient about the risks involved.
What complications can emerge due to a pressure sore?
While a pressure sore on the surface does not sound incredibly dangerous, it can carry a great deal of risk if it transitions into an open wound and is not identified/treated quickly enough, and occasionally these can be life-threatening.
Infection is one of the most serious risks. As pressure sores often develop in areas of the skin that are in close proximity to a bone, osteomyelitis (bone infection) is a prominent concern following a Grade 3 or Grade 4 pressure ulcer. These can be extremely dangerous depending on the nature of the infection, and may require the bone or joint to be surgically removed.
Septicaemia or blood poisoning is another risk to be wary of. This is where the infection in the pressure sore spreads through the bloodstream into other organs which in serious cases can result in a large drop in blood pressure, known as septic shock, which can be fatal.
Other potentially dangerous consequences of a pressure sore that reaches Grade 3 or 4 include:
- Cellulitis – an infection that spreads from the ulcer into a deeper layer of skin
- Necrotising fasciitis – also known as “flesh-eating bacteria”, this is a serious skin infection that can lead to the rapid death of tissue around the wound
- Gas gangrene – a rare infection where the pressure ulcer is infected with clostridium, which releases dangerous toxins that can cause severe pain and swelling
- Damage to the heels that can make walking painful and challenging
- Development of extensive necrotic tissue which may require amputation to remove the threat of life-threatening infections
As you can see, pressure sores can be more serious than you may have anticipated. That is why we take negligence claims of this nature as seriously as we would any other incident.
Making a claim for pressure sores
While in certain instances pressure sores are unpreventable, in the majority of cases they can be attributed to substandard or negligent care. This could be due to:
- A failure to ascertain a patient’s Waterlow Score, meaning their risk of developing a pressure sore is not taken into consideration
- A failure to follow the prevention plan recommended by the patient’s Waterlow Score, or generally inattentive or negligent nursing care
- Not effectively monitoring or checking the patient for signs of bedsores developing during their stay in hospital
- Not correctly diagnosing symptoms of a pressure sore early enough before it developed into an open wound or infection
By working closely with nursing care experts and comprehensively retracing the treatment that took place, we provide our clients with an accurate assessment of if the harm they or their loved one endured was due to negligence.
Once this is established, we are there to guide them through the process of pressure sore medical negligence claims, with a firm focus on ensuring they receive the compensation, justice and closure they are seeking.
If you or someone you care about has suffered as a result of negligible nursing care, talk to a team you can trust. Get in touch today to discover how we can support your claim.
All content contained within this article is meant for general information only – this should not be treated as a substitute for medical advice from your doctor or another healthcare provider. If you require legal advice specific to your situation, please contact our team directly.
Gadsby Wicks is not liable for any diagnosis made from the content of this article, nor does it endorse any service or external site linked to within the article.
Always consult your GP if you are concerned about your health and wellbeing, or speak to us if you require legal advice.