Pressure Injuries Due to Neglect

Whether in hospital or a care home setting, pressure injuries should never occur.

If your relative develops a pressure injury while in hospital or at their care home, they may have a claim for negligence.

Pressure injuries arise as a result of neglect; pure and simple. Inadequate risk assessment, poor care, or a lack of staff resources are some common contributing factors.

A pressure injury – sometimes referred to as a pressure sore, bed sore or pressure ulcer – occurs when continuous, prolonged pressure or friction is applied to an area of the skin. Restricted blood flow causes damage to the skin and underlying tissues, resulting in the formation of an ulcer. Pressure ulcers can develop very rapidly, becoming a serious injury in a matter of days. Failure to diagnose and treat early on can result in lengthy and painful suffering, major complications and even death.

People with restricted mobility are at increased risk of pressure injury, especially if they are reliant on others to alter their position. Patients who have to remain immobile whilst recuperating after major surgery or who are under heavy sedation (or induced coma) are at significant risk. Equally, certain medical conditions are known to increase the risk of pressure injury, either due to poor circulation (e.g. heart and lung conditions, diabetes, obesity) or reduced sensation or awareness (e.g. spinal injuries, stroke, dementia). Bony prominences with little adipose tissue – such as the heels, hips and sacral area – are particularly vulnerable.

The most important intervention to mitigate the risk of pressure injury is regular positional changes; the higher the risk, the more frequently repositioning will be required. Prompt personal hygiene care and the regular application of emollients and barrier creams are also essential. For people restricted to a bed or chair, various pressure relieving devices are available, such as cushions, bootees, wedges and airflow mattresses.

The risk of pressure injury is measured using the “Waterlow” scale – a simple tool that considers a range of risk factors and assigns a score. The higher the score, the greater the risk. Risk assessments should be carried out regularly to review skin integrity and ensure the measures in place to mitigate the risk are sufficient and effective.

In the majority of cases, pressure injuries arise due to an inaccurate assessment of risk, or a failure to provide adequate care to mitigate the risk identified. This amounts to negligence.

Pressure injuries are “graded”, “staged” or “categorised” in order of severity, from 1 to 4, with 1 being the least severe and 4 the most severe:

• Grade 1 – non-blanchable erythema (i.e. unbroken skin)
• Grade 2 – partial-thickness skin loss
• Grade 3 – full-thickness skin loss, extending into subcutaneous tissue
• Grade 4 – full-thickness tissue loss, with exposed bone, muscle and/or tendon

Grades 3 and 4 are usually the cause of litigation against the NHS or care homes for negligence. Injuries of this severity put the patient at serious risk of infection and can be very difficult to treat, requiring specialist interventions such as surgery, vacuum treatment and even amputation.

In a hospital setting all pressure ulcers Grade 2 and above should be reported on admission.

You may be entitled to compensation if you have sustained a pressure injury as a result of improper care. Why not call us on 0800 011 4136 or 0161 272 5222 or enquiries@farleydwek.com for a FREE consultation.