Pressure Sores – What you need to know

By Benjamin Ho

Pressure sores (or bed sores) are wholly avoidable injuries, so long as appropriate care for a patient is taken. When it is not, they can become serious injuries.

What are pressure sores?

Pressure sores are lesions or wounds that form around prominent bony areas of the body such as the hips, lower back, tailbone, heels, back of the head or elbows. They break down the skin around the area under ‘pressure’ and leave the underlying skin exposed.

Pressure sores are also known as “bedsores” and “pressure ulcers.” The damage caused can range from discolouration of the skin to exposed muscle tissue or even bone.

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Causes of pressure sores

Pressure sores develop when a person’s skin is in contact with a surface for an extended period of time. In a medical context, this can occur when a person is in a wheelchair or bed-bound for a sustained amount of time.

Where the skin is in contact with a hard surface, blood and therefore oxygen is restricted from reaching the skin tissue. If a person is not regularly moved to alleviate this pressure, the tissue at the affected site can begin to die.

Once an ulcer has begun to develop, an infection can occur, particularly if the area is moist or the person is more vulnerable to infection.

Grades of pressure sore

There are four grades of pressure sore.

Grade 1 – The wound is largely superficial, with the affected area of the skin appearing discoloured. If you have white skin the sore will appear red, whilst, in those with darker skin tones, it can appear blue or purple. Grade 1 sores will not turn white when pressure is applied and generally, the skin remains intact. The texture of the skin is unlikely to be affected, however, feeling warm, spongy or hard and general discomfort is commonplace as a result

Stages of pressure sores
Stages of pressure sores

of itching or aching.

Grade 2 – Where the outer layer of skin (known as the “dermis”) is damaged, and skin has been lost. These pressure sores resemble an open wound or a blister.

Grade 3 – Multiple layers of skin are damaged and further damage has also been inflicted on the underlying tissues. Whilst muscle and bones remain unaffected, the injury comes to resemble a deep cut or cavity-like wound.

Grade 4 – The most severe form of pressure sore. Here the skin is so badly damaged that surrounding tissues begin to die (a condition known as “tissue necrosis”), and damage may also have occurred to underlying bone and muscle. These cases also carry the most significant risk of developing a serious and life-threatening infection.

Blackwater Law medical negligence solicitors made a successful hospital negligence claim for the family of an elderly patient who fell out of bed.

Hospital beds in a corridor

Pressure Sore Negligence

In the more serious cases, those involving Grade 2, 3 or 4 pressure sores, there may be a strong argument for making a pressure sore claim due to the fact care may have been to a substandard level for a period of time long enough for the wounds to deteriorate to such an extent.

All bed sores can cause a great deal of pain and difficulty moving. Many take a long time to heal properly, and some may never heal at all. The elevated risk of infection can also lead to further health problems later, or delay recovery from their primary ailment.

Where clinical negligence on the part of hospital or care home staff can be proven to have caused or worsened any of the injuries related to pressure sores, regardless of the grade of the bed sore, you may be entitled to make a claim for compensation for you or your family member.

Have you developed a pressure sore in hospital?

If you have developed a serious pressure sore in hospital, you may have a strong claim for compensation.

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Treatment of Pressure Sores

Should you or a family member suffer from bed sores whilst in a hospital or a care home, there are a few measures that should be taken to alleviate suffering.

Even in the least severe cases, pressure ulcers represent discomfort and inconvenience and will require additional care. Dressings, creams, and gels may be applied to address the pain and speed up the healing process. In more serious cases surgery may be required to remove damaged tissues that cannot be saved and that pose an infection risk.

Where care is so poor that bed sores are allowed not just to appear but to remain and grow, patients may fall victim to life-threatening complications such as blood poisoning or even gangrene.

There is much guidance published by the NHS on how to prevent pressure ulcers and hospital and care home staff should be following these, often simple, procedures. Preventative measures include regularly changing patients’ positions to alleviate pressure applied to the same areas of the body.

For example, those that are wheelchair-bound should change position as regularly as every 15-30 minutes, whilst those that are bed-bound should change position approximately every two hours, according to best practice. Whilst changing position is the most effective preventative measure, ensuring a patient eats a balanced nutritional diet is also key, particularly when recovering from existing pressure sores.

Whilst it isn’t always possible to prevent bed sores in the most vulnerable patients, adequate protection and treatment methods should always be applied. Measures include preventing any pressure from applying to an area of the body already affected, properly dressing wounds, and changing this dressing regularly. Should care home or hospital staff fail to do this, it will likely influence the outcome of any prospective claim for pressure sores that patients might make.

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