Pressure Ulcers and Medical Negligence
An undiagnosed and untended pressure ulcer, or pressure sore, can lead to life-threatening infection. Careful monitoring of at-risk patients is required to prevent such outcomes.
Why are pressure ulcers a serious issue?
A bedsore sounds like an inconspicuous and non-threatening skin problem which will clear up once the patient has the correct treatment.
Serious bed sores, or pressure ulcers, can in fact develop into deep tissue damage, affecting muscle and bone and threatening the life of the patient if they lead to sepsis or cellulitis.
Pressure ulcers are classified according to degrees of severity in order to assist the management of the condition. The most serious stage of ulcer is a Grade 4 ulcer, described as the following:
extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures with or without full thickness skin loss.'
Life-threatening infection
Where a pressure ulcer allows the patient to develop an infection, sepsis can be an associated problem. Where treatment is delayed, sepsis can quickly lead to multiple organ failure and the death of the patient. Even where the patient survives, the long-term impact of sepsis can be debilitating and life-changing.
NICE Guidelines of Pressure Ulcer Management
There are clear guidelines from NICE (the National Institute for Health and Care Excellence) as to the risk assessment and management of pressure ulcers or sores. These guidelines emphasise the fact that anyone can develop a pressure sore but that some patients are more susceptible than others and need careful assessment and on-going monitoring.
On admission to NHS care, the guidelines recommend the following:
Carry out and document an assessment of pressure ulcer risk for adults being admitted to secondary care or care homes in which NHS care is provided, or t hose receiving NHS care in other settings if they have a risk factor:
- Significantly limited mobility
- Significant loss of sensation
- A previous or current pressure ulcer
- Nutritional deficiency
- The inability to re-position themselves
- Significant cognitive impairment'
Similar guidelines are offered regarding children and infants.
It is further recommended that an assessment takes into account the whole picture of the patient's health and well-being. Factors such as cognitive ability should be taken into account in order to assess the patient's ability to communicate their concerns or to understand threats to their health.
At risk of a pressure ulcer
Although anyone can develop a pressure ulcer, certain other categories of patient are particularly at risk including the following:
- Someone undergoing a prolonged surgical procedure
- Someone who requires or experiences a sustained period of immobility whilst in hospital
- The elderly
- Those who are significantly overweight
- Someone who smokes
Management of pressure ulcers
Where a patient is identified as being at a particular risk of developing a pressure ulcer, it is recommended that frequent re-positioning should be carried out in order to relieve pressure on one particular area as well as the possibility of providing a foam mattress to reduce the development of pressure. Additional methods for relieving pressure on key areas and the application of barrier cream should be considered as well.
Where a patient is at risk, regular observation of key areas of the body for signs of any development of a pressure sore or ulcer should be incorporated and part of the management strategy for that patient.
Symptoms of a pressure ulcer
Early symptoms of a pressure ulcer such as discolouration of the skin and associated itchiness should prompt action to relieve pressure in that area and alert medical professionals to the need for close monitoring.
Untreated, this can soon develop into an open wound, facilitating far greater threats to the well-being and life of the patient.
Medical negligence
A failure to risk-assess patients thoroughly and to act on any findings of susceptibility might be considered to have been negligent.
A failure to observe the symptoms of a pressure ulcer, especially in at-risk patients where close attention should be expected, might be considered to be substandard care.
If you or a loved one have suffered the significant and long-term impact of a pressure ulcer, contact us to discuss your experience with a specialist medical negligence solicitor.
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