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Pressure Sores Explained

What are pressures sores?

Pressure sores, also know as pressure ulcers or bed sores, are damage that occurs to the skin and underlying tissue, and in severe cases, the bone.

As the name suggests, they are typically caused when too much pressure is applied to the skin. They can also be caused when the layers of skin are forced over other tissues, such as sliding down a bed or transferring to and from a chair, and by friction.

Types of the Pressure Sores

Pressure sores are graded from 1 to 4, depending on the severity of the pressure sore. They range from grade 1, being minor, to grade 4, being severe.

Grade 1: In grade one pressure ulcers the skin is intact but discoloured. The area is usually red in fair skinned people, and purple or blue in people with darker skin. The area may be itchy or hurt, and can feel either warm, or hard.

Grade 2: A grade 2 sore will have partial-thickness skin loss, or damage to the 1st and 2nd layers of the skin, which may include the nerves. The wound will be open or may look like a blister.

Grade 3: In grade 3 pressure sores there will be full thickness loss involving damage to the deepest layer of skin. The wound will be open and deep.

Grade 4: Grade 4 pressure sores are the most severe. There will be full thickness loss, and destruction of the skin. The skin tissue may also die (necrosis) as a result of the lack of blood supply. The bone may also be damaged. People who suffer from grade 4 pressure sores are more likely to suffer from an infection.

At first, the skin may appear discoloured, which gradually then deteriorates to being an open wound.

It is important to identify pressure sores early on so that steps can be taken to prevent the sore from deteriorating.

Who is at risk of suffering pressure sores?

Whilst anyone can get a pressure sore, some people are at a higher risk of developing one.

The National Institute for Health and Clinical Excellence (NICE) has identified those groups of people who are considered high risk of developing pressure sores. By identifying these groups, the aim is to prevent the pressure sores from developing.

People at higher risk of developing pressure sores

- those who have difficulties moving and are unable to change position by themselves, for example the elderly
- the elderly or very young.  This is because older people have poorer circulation.
- people who cannot feel pain over part or all of their body
- people who suffer from incontinence. Moisture can make the skin soft, which can lead to breaks in the skin.
- seriously ill people, or those who have undergone surgery and are therefore in bed
- people who have had a pressure sore before, may be more prone to suffer a further sore in this area. This is because the skin is weak.
- people who have a poor diet or don’t drink enough fluids. This is because the skin and other tissues do not get the nutrition that they need to be healthy.
- people who have suffered a spinal cord injury and are unable to feel or move parts of their bottom and legs
- older people who may have undergone hip replacement surgery

What steps can be taken to reduce the risk of pressure sores?

Whilst pressure sores may be inevitable in some cases, most pressure sores can be avoided, and this is why it is important that healthcare providers identify the risks and take steps to try and prevent the pressure sores from developing or deteriorating. This means relieving the pressure on bony parts of the body which are more prone to pressure sores. This includes the bottom, heel, hip, elbow, shoulder, back and the back of the head.

Guidelines recommend that patients are risk assessed for pressure sores within 6 hours of being admitted to hospital. Those patients not considered to be at risk must be reassessed when conditions change. For example, if the patient is unable to leave the bed, or is not eating or drinking.

Pressure sores when left untreated can lead to pain and sometimes in very serious cases death. It is therefore important that steps are taken to prevent the development of the sores.

Reducing the risk:

1. NICE recommends relieving pressure on bony parts of the body by keeping the patient moving, and frequently changing positions. This is particularly important if a pressure sore has developed because a further pressure is likely to cause the skin further damage, causing the sore to deteriorate.

2. Special pressure relieving mattresses and cushions can also help to reduce the pressure on areas prone to sores. These can be provided for use in the home, and also in hospital / care homes.

3. It is worth noting that extra precautions need to be taken where people are at high risk of developing a pressure sore, or have already developed a grade 1-2 pressure sore. For these people, a high specification foam mattress should be used. This can relieve pressure, and can prevent pressures sores from developing. For those people who have a grade 3-4 pressure sore, an alternating pressure system or continuous low pressure system mattress should be used. These are more effective in relieving the pressure when sores are severe.

4. Regular checks of the skin. Redness, blisters, hot skin, welling, and patches of cool skin can all be indicative of a pressure sore. If any of these signs are present, extra steps should be taken to reduce the risk of deterioration.

5. It is important to eat well and drink plenty of fluids.

Treating pressure sores

Treatment of pressure sores will depend on the severity of the sore, where the ulcer is, the patient’s general health and ability to change position themselves. The aim of the treatment is to treat the sore and also relieve any pressure to prevent further damage.

Treatment can include dressing the area, removing any damaged skin, and in some cases, surgery may be necessary. Anti biotics are likely to be prescribed if there is an infection.

Dressings

Dressings including gauze, paraffin gauze and simple dressing pads are no longer recommended. Dressings with gel pads are now recommended as these clean the area and help to keep it moist. Foam dressings are also used because these absorb and retain the fluid.

Removal of dead skin

This encourages the pressure sore to heal, and can be done with dressings or by cutting the dead skin away.

Surgery

In severe cases, surgery may be advised to help close the wound. This may be advised in cases involving a large grade 4 pressure ulcer.

Coping with pressure sores

Pressure sores can be extremely painful and debilitating. They can also take a long time to heal, particularly if the deep layers of skin or muscle are damaged. This can significantly affect a person’s life, regardless of how old they are. Patients are likely to need regular assessment and intervention by a district nurse.

In some cases, pressure sores can become infected, which can lead to blood poisoning or bone infections. It is therefore important that the area is kept clean so that it does not become infected.

Thompsons Solicitors succeeded in obtaining compensation for a patient who suffered grade 4 pressure sores to both heels as a result of poor nursing care. The patient suffered open wounds for 12 months after the injury, and was unable to leave the house or wear shoes. This is an example of how pressure sores can affect a person’s quality of life.

In another case, we obtained compensation for a lady who suffered from a lot of discomfort after suffering a grade 2 pressure sore to her sacrum. The client suffered from numbness and pain when she sat down, found it uncomfortable to sit for prolonged periods, suffered from tooth ache like pains in the area, had to regularly change positions when sitting down, and had to sleep on her left side to avoid pressure to the right side. She was also at an increased risk of suffering a further sore in this area.

Claiming compensation for the development of pressure sores

As previously mentioned, whilst pressure sores can sometimes be inevitable, they can be prevented in most cases.

What you need to prove to be successful in a claim

To be successful in a claim, you need to prove that the level of care you received fell below a reasonable standard, which led to the development of a pressure sore, or led to an existing pressure sore deteriorating.

For example, a failure to risk assess a patient of being high risk of developing a pressure sore may constitute sub standard care. Also a failure to take preventative measures include moving the patient on a regular basis and providing correct pressure relieving mattresses, may constitute sub standard care.

Thompsons have successfully obtained compensation for clients who have developed pressure sores as a result of sub standard care, and continue to act for clients in such cases. Our cases have involved younger patients who developed pressure sores following gallbladder surgery, elderly patients who suffered severe grade 4 pressure sores to the heels and toes following hip replacement surgery and patients who suffered pressure sores whilst receiving respite care in a residential home and whilst in hospital following surgery.

If you are concerned that you or a family member may have developed a pressure sore as a result of sub standard care, telephone us now for accurate advice on a claim.

Time Limits

There are strict time limits in place to make any personal injury claim. For further information, contact us or visit our Questions Answered page.

Thompsons Solicitors are experts in all matters relating to clinical negligence and will be able to advise you as to whether or not you have a valid personal injury claim for compensation. Our specialist clinical negligence solicitors and lawyers will be happy to talk you through the process of making a claim and will be happy to answers any questions or queries that you may have.

Telephone us now on 08000 224 224 or complete one of our online personal injury compensation claim forms.