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What Visitors Don't See – A Guide to Pressure Sores

Author: Neil Fearn  Bullet  Dated: 13/05/2015

Research shows that 80 – 95% of all pressure sores, also known as pressure ulcers, could have been avoided, and 700,000 people are still being affected by pressure sores each year. But do you know what pressure sores are, and how do you know if your relatives are being cared for properly to prevent them?

Are your relatives suffering from pressure sores or ulcers?

The Royal College of Nursing (RCN) and National Institute for Health and Care Excellence (NICE or the Institute) have developed a clinical guideline on the management of pressure ulcers in primary and secondary care which makes provision for person-centred care.

These guidelines include:

  • Patients and carers should be made aware of the Guideline and its recommendations
  • Patients and carers should be involved in shared decision-making about the management of pressure ulcers.
  • Health professionals are advised to respect and incorporate the knowledge and experience of people who have had, or have, a pressure ulcer.
  • Patients and carers should be informed about any potential risks, and/or complications, of having a pressure ulcer.

What is a Pressure Sore?

A pressure ulcer is an injury to the skin caused by pressure being applied. This can be the case if a lot of pressure is inflicted on a certain area, or if a small amount of pressure is applied over a length of time.

The ulcers can vary from being relatively minor and requiring little care, to being quite severe and require debridement or plastic surgery. If sores are left untreated, they can worsen and become difficult to treat, leading to other complications like gangrene or blood poisoning.

The European Pressure Sore Advisory Panel Grades/Categories of pressure ulcers (sores) are usually used in Britain to indicate the seriousness of the area in question with 1 being a reddened area, no broken skin, to 4 being severe tissue damage involving the tissues and structure down to the bone.

Finding out your relative has a pressure sore can be very upsetting, and can make you think that your relative is not receiving the right care and attention. You may feel helpless, as it is something that you couldn't have spotted even during regular visits.

It can be especially distressing if your relative is unable to explain the pain that they are experiencing. The charity Alzheimer's Society highlight that some people with advanced dementia can be completely unable to communicate with others to explain that they are in pain.

Who Gets Pressure Sores?

People with health problems that restrict movement and confine them to a bed are most commonly affected, and also people in care homes as they spend long periods of time resting. Although elderly people can be more susceptible to pressure sores due to reduced mobility and a weakening of the skin, people of any age could fall victim.

Pressure sore awareness campaigners, Your Turn, highlight how someone of any age could suffer from a pressure ulcer. They detail how 'Sarah, aged 9, got a pressure ulcer on her heel after having an operation on her broken leg', and 'Josie, aged 28, had a pressure ulcer after giving birth to her first child and having an epidural.'

Does my Relative Have a Pressure Sore?

It can be difficult to see if they have any pressure sores, or even to see if they are getting the right care to prevent them. When you go to visit family or friends in hospital or in care homes, clothes and bedding will often hide the places that pressure sores start forming.

If the air mattresses are not set correctly to correspond with the person’s weight they are not effective and it would be crucial that this was checked. Even with an air mattress and cushion in place, if the rest of the care is not in place associated with preventing pressure sores they will not be effective. Health care professionals should ensure regular positional changes and skin inspections and a turn chart is maintained. This can usually be found at the foot of the bed.

Diet and Hygiene

A Nutritional Care Plan should also considered with food and fluid intake managed apprpriately as proper nutrition and hydration can help reduce the risk of pressure sores. If you can see that your relative loses weight it may be that they are dehydrated and lacking in a good nutritional diet and require a further assessment as this could have a significant impact on the deterioration of their pressure areas, this is reversible and a referral to the Dietician would be appropriate. It may be the case that your relative has difficulties with swallowing, if so, then you should expect health care professionals to make a referral to the Speech and Language Therapist (SALT) for assessment, and you can ask whether this has been done.

Personal hygiene and incontinence are other factors which are considered during the initial assessment. If your relative has difficulties in performing these tasks independently this may lead to skin breaking down, especially if they are left in wet bedding or pads for long periods of time. If this an issue you should expect to see a detailed care plan in place as to how the staff are going to manage this, what size pads etc with regular checks being made on whether you’re your relative had been toileted, again this is something that you can check.

Remember, all care should be documented in the patient's health care records.

If an ulcer has started to form, then this should be documented and be supported by tracings and or photography. A referral to the Tissue Viability Nurse (TVN) should be made. The TVN offers support and advice to patients, carers and health care professionals on complex wound management and techniques and recommends appropriate treatment to aid healing.

Pressure ulcers are avoidable with the right care, and nobody should have to experience unnecessary pain and distress. Research shows that those who suffer from pressure ulcers pressure have a reduced quality of life as do their carers and their families and they often require long term primary and secondary health care, resulting in substantial costs to the NHS. Pressure sores cause much pain, discomfort and inconvenience and have an increased risk of death in the elderly.

If you or a relative feel that you suffered unnecessarily and didn't receive the right care, you may wish to get professional advice on potential medical negligence.

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