On 21 November 2024, we observe the annual International Stop The Pressure campaign, helping to raise awareness of pressure injuries, in the hope of reducing the number of avoidable pressure wounds.
Pressure ulcers, also known as pressure sores, pressure injuries and bedsores, remain a concerning and largely preventable injury in care and hospital settings.
In the UK, over 700,000 people are affected by pressure ulcers each year. Of these, 180,000 are newly acquired, 60% of which occur in people over the age of 70.
What is a Pressure Ulcer?
A pressure ulcer is an area of damage to the skin and underlying tissue.
It is usually caused if you have difficulty moving, if you are seated or lying down for an extended period of time without help in moving and rotating, or without suitable equipment. Skin begins to blanch and breakdown leading to an ulcer either gradually or over a few hours.
Where do Pressure Ulcers typically form?
Pressure ulcers often occur in bony areas such the bottom or lower back, the elbows, shoulders, heels, and the back of the head.
How are Pressure Ulcers graded?
Pressure sores are graded between 1 and 4, depending on their severity:
- Grade 1 – The skin is intact but may appear discoloured, hard, itchy and may feel warm to touch.
- Grade 2 – Partial skin loss presenting as an open wound or a blister.
- Grade 3 – Full thickness skin loss. The underlying muscle and bone will be undamaged. The sore will look like a deep wound.
- Grade 4 – full thickness skin loss with damage to the muscle or bone, which may be exposed and can become infected.
Who is at increased risk of developing a Pressure Ulcer?
Generally, certain groups of people are at a greater risk of developing pressure ulcers, including those who:
- Have difficulty moving and cannot move themselves, for example, due to an illness, are in intensive care or recovering from surgery;
- Are incontinent;
- Are underweight;
- Have poor circulation or fragile skin;
- Have problems feeling sensation or pain;
- Have a previous grade 3 or 4 pressure ulcer.
Patients in hospitals and care are particularly vulnerable to developing pressure ulcers because they usually have one or more of the above risk factors.
How can a Pressure Ulcer be prevented?
In hospital, as early as within the Accident and Emergency Department, a person’s risk of developing a pressure ulcer should be obtained through staff carrying out a risk assessment.
The Waterlow score is the most widely used risk assessment tool in NHS Trusts. It uses a chart to work out a person’s risk of developing a pressure ulcer based on factors such as their BMI, continence, skin type, mobility, age, appetite, tissue malnutrition, and any major surgery or trauma.
A score of 10-14 indicates that a person is at risk, whilst a score of 20 and above places a person at very high risk.
Prevention: What steps should be taken if a patient is at high risk?
If a risk assessment identifies that a person is at risk of developing a pressure ulcer, the following steps should be taken:
- Encouraging a person to change their position frequently if they can;
- Repositioning a person who is unable to move on their own;
- Providing pressure relieving equipment;
- Regularly washing and drying the skin to keep it clean and healthy;
- Frequently checking and monitoring a person’s skin.
Treatment: What steps should be taken if a person develops a Pressure Ulcer?
If a person develops a pressure ulcer, the following steps should be taken:
- Ensuring a person is regularly rotated and repositioned by following turning schedules;
- Providing a pressure relieving equipment such as a pressure relieving mattress or cushions;
- Seeking specialist input from a Tissue Viability Nurse as to treatment;
- Regular dressing and assessments.
When is a Pressure Ulcer Considered a Result of Negligent Care?
NHS England support the National Stop the Pressure campaign and explain that pressure ulcers are an avoidable and costly harm. They are largely avoidable and arise due to inadequate preventative measures or poor nursing care.
There are also some instances where a person develops a pressure ulcer and the nursing staff failure to provide adequate treatment or rotation schedules, resulting in the injury worsening.
The Stop the Pressure campaign is hosted by the Society of Tissue Viability in collaboration with the National Wound Care Strategy Programme.
At Tozers, we act for clients who have suffered significant injuries due to pressure injuries, and seeing the life-changing impact this can have, we fully support the awareness campaign – Let’s STOP the Pressure together.
The theme for 2024 is inclusivity, asking “Are you Really LOOKING, are you Really LISTENING” to help clinical staff and patients understand the importance of wound prevention and management.
We hope that this will encourage improvement in patient safety and a reduction in the number of pressure injuries acquired in the UK.
What should I do if I have, or someone I know, has developed a Pressure Ulcer whilst in hospital?
If you or a family member have suffered an avoidable pressure ulcer whilst under medical or nursing care, a member of our clinical negligence team would be happy to speak to you, to see if your circumstances warrant further investigation. Please note that we act exclusively for claimants, and subject to risk, we can act on a no-win no-fee basis.
