Pressure sores: Inevitable or negligent care?

Do they just happen, or are they caused by negligence?

What is a pressure sore?

A pressure sore, also known as a bed sore or pressure ulcer, is a localised injury to the skin and/or underlying tissue that usually occurs over a bony prominence due to prolonged pressure, or pressure combined with shear and/or friction.

These sores often occur in individuals who are bedridden or have limited mobility, which prevents the regular shifting of position that normally helps to distribute pressure. 

Often, the care of pressure sores falls under the specialist area of tissue viability.

How common are pressure sores?

Globally, the incidence of pressure sores in healthcare settings is between 0 and 72%, demonstrating significant discrepancies across various geographical and clinical environments.

In the UK, pressure sores affect more than 700,000 individuals annually, with 180,000 of these cases being newly reported each year (Wood J, Brown B, Bartley A, et al Reducing pressure ulcers across multiple care settings using a collaborative approach BMJ Open Quality 2019). 

Research indicates a rise in the incidence and prevalence of pressure ulcers with advancing age [BMJ, Best Practice 2021; OHID, 2022]. Over 60% of ulcer cases are found in individuals who are over 70 years old.

The common stages and characteristics of pressure sores

Stage 1: The skin remains intact, but it may appear red or discolored, particularly in individuals with lighter skin tones. The area may feel warm to the touch and may be painful or have a different texture compared to the surrounding skin.

Stage 2: The outer layer of the skin (epidermis) and part of the underlying layer of the skin (dermis) are damaged or lost, forming a shallow open sore. The wound may also present as a blister filled with clear fluid.

Stage 3: The wound extends into the deeper layer of the skin, revealing a crater-like sore that might expose some of the fat tissue.

Stage 4: The sore is very deep, reaching into muscle and bone and causing extensive damage. It may involve necrosis of the tissue, and there’s a high risk of infection.

Unstageable: In this stage, the sore is covered with yellow, tan, green or brown tissue, and it is not possible to see how deep the wound is.

Suspected Deep Tissue Injury (SDTI): The skin may be intact or non-intact, and it usually has a purple or maroon localized area of discolored intact skin or a blood-filled blister due to damage of underlying soft tissue.

Pressure Sores: Inevitable or Negligent Care?

Preventing pressure sores

Here are some of the ways to prevent pressure sores:

  • Frequently repositioning individuals with limited mobility
  • Keeping the skin clean and dry
  • Using pressure-relieving devices like specialized mattresses or cushions.
  • When a pressure sore develops, it requires prompt medical attention to prevent infection and further complications.

Whose responsibility is it to prevent pressure sores?

For patients who are under active medical or nursing care, the responsibility for preventing a pressure sore is the care team which oversees the individual’s care.  Mostly, the responsibility falls to nurses and care staff; however, doctors may also have responsibility if the pressure sore requires the specialist intevention of a plastic surgeon. 

Nursing staff who are responsible for pressure sore management require specialist training to achieve the competency to safely deliver sore care. The National Institute for Health and Care Excellence (NICE) publish quality standards for the management of the sores, and NHS England publish a core curriculum to inform the knowledge base for pressure sore practitioners, or those working in tissue viability.

How can Expert Court Reports help?

Expert Court Reports Ltd is a leading provider of expert witnesses. We represent multiple medical and non-medical specialties.  We have a number of nursing expert witnesses who are the most instructed expert witnesses in clinical negligence claims arising from pressure sore management. 

Our nurses work in a range of clinical settings.  We have an advanced nursing practitioner, Wendie Smith, whose portfolio of clinical work specifically includes tissue viability.  We have a dual trained nurse (general and mental health nurse), Tanya Moffet, who has expertise in appraising the care delivered in nursing home settings whose experience is sought after in such cases. 

In cases where plastic surgery expertise is required, our plastic surgeon expert witnesses, Mr Jeremy Birch and Mr Wee Sim Khor, are available for instructions relating to pressure sore and tissue viability clinical negligence claims.

Get in touch

Expert Court Reports provides expert witnesses, and medico-legal court reports for solicitors, barristers and other agencies, including the police, probation services, prisons, and third-sector organisations, as well as private clients.

To discuss any issues raised in this article, please call us on 01865 587865, email, or request a call by completing our online form.