The Daily Mirror today reports that the NHS has now spent £16 million on compensation to 700 people who suffered bedsores (pressure sores or pressure ulcers). This is staggering. Not because of the sums involved, but because of the fact that these were all man made injuries (iatrogenic).
Pressure ulcers form as a result of unrelieved pressure. It is simple to prevent them. You do not leave patients who are unable to move lying or sitting in one position for too long. In some cases a special pressure relieving mattress can be used to constantly vary the pressure on different parts of the body throughout the day.
Pressure ulcers have 4 (sometimes 5 depending upon which classification is used) stages. Stage 1 is just an initial redness indicating excessive pressure. This should be picked up during routine nursing checks and during hygiene maintenance. There can sometimes be minor skin excoriation (tears) from friction with sheets.
Stage 2 is when the skin starts to break down. Stage 3 is the ulcer forming and the tissue underneath being damages. Stage 4 is when the tissue has died and in some cases the bone underneath is visible.
All nursing staff should know how to assess a patient for their risk of developing pressure ulcers upon admission to hospital. However that is not the end of the assessment. It should be continuous throughout any stay and reflect any changes in mobility, condition and drug treatments. Some patients may be mobile upon admission but become less so due to drugs and deterioration or surgery.
Ensuring basic hydration and proper nutrition is key to helping prevent such injuries but that requires time to ensure patients are eating or getting help to eat and drink if they struggle.
There are some circumstances where moving a patient may cause unnecessary distress (terminal care) or where someone has such advanced diabetes that no amount of care will prevent the damage. These reflect about 5% of pressure ulcers (although the increase in prevalence may mean that statistic is out of date).
Pressure ulcers can allow infections such as MRSA to colonise or mean that surgery is required to debride the wound and allow healing to start. Hospital stays are extended and pressure on beds is increased. The cost of nursing the affected area is also an additional cost that was not expected when the patient was admitted. The impact in terms of long term scarring and risk of further ulcers is there with the patient for life.
It is a worrying indictment of modern standards that Florence Nightingale understood how to prevent these and considered them an indicator of poor nursing. It is hard to see how science will have gone backwards on this.
Causing a pressure ulcer amounts to easily avoidable medical negligence. That they are increasing is in part due to staffing pressures but also due to a lack of training and awareness. These are something that should be eradicated almost completely from modern healthcare. It is not just the cost of compensation for the injured but also the additional treatment costs and bed pressures that make this a priority. In this writers opinion pressure ulcers are almost “never events” and should be treated as such by those in charge of standards at any hospital.
I have seen an increase in the number of pressure sore cases over the last 10 years and that is something that is surprising given how preventable they are.