Pressure sores are open wounds that form as a result of prolonged pressure applied to the skin. They are not a new phenomenon yet they continue to plague the disabled, elderly and chronically ill. If there is an active care programme in place, 95% of pressure sores are preventable. Sadly, the chances of suffering a pressure sore depends on which hospital you stay in, making it yet another postcode lottery.
Based on current statistics published by individual hospital trusts, the Princess Alexandra Hospital in Essex is the worst hospital in terms of pressure sores. The chance of a pressure sore turning into a grade 3 or 4 sore was over 51%. This is closely followed by Kingston and the Chelsea and Westminster Hospitals where the statistics are 28% and 24% respectively. A grade 3 or 4 pressure sore are the worst kinds which means that there is such extensive tissue damage that you can sometimes see through to the bone.
So, are pressure sores serious?
Yes. Even if pressure sores don’t develop further complications they can still disable patients. Often they develop on heels or the lower back which makes standing or sitting very painful. For elderly patients who already have mobility problems this additional debility can be disastrous. When complications do develop it can lead to bone or joint infections, sepsis and ultimately death.
The tragic fact is that almost all instances are preventable which means that appropriate care is clearly not being provided. Some of the better NHS Trusts who seem to have the problem under control include Basildon and Thurrock NHS Trust where no patients went on to develop grade 3 or 4 pressure sores in 2013. This is clear evidence that these appalling and preventable sores can be conquered.
How can they be prevented?
Factors which can lead to pressure sores are well known to medical staff and these include immobility, weight loss, friction to the skin, a poor diet, diabetes, bad lifting techniques and improper patient positioning.
In September 2005 the National Institute of Clinical Excellence (NICE) produced a guide called “The Prevention and Treatment of Pressure Ulcers” which identified recommendation to reduce the incidence of pressure sores. Some of the key recommendations were;
- Patients should receive an initial and ongoing risk assessment in the first episode of care and thereafter with photographs and/or tracings;
- All patients who are vulnerable to pressure sores should at the least be placed on a high specification foam mattress or put on a turning regime;
- For patients who are having surgery there should be a high specification foam theatre mattress
In simple terms patients who are at risk should not stay in the same position for more than 2 hours, their skin should be checked regularly and specialist mattresses or pillows should be used.
What action can be taken?
Hospitals can and must be held accountable for care which falls below a reasonable standard. If a patient develops pressure sores because of improper care they can claim compensation. If a patient dies having developed pressure sores, the family may be able to claim on behalf of the deceased. The level of compensation depends on the severity of the pressure sore, how many there are and how quickly they can be treated.
The NHS were campaigning and running a “Stop the Pressure Month” in November 2014 which they hoped will raise awareness and reduce pressure sores. This campaign has actually been running since 2012 with some success but unfortunately not enough. We will watch with bated breath in the coming months to see if care surrounding pressure sores improves.clinical neglig