We have been acting for the family of the deceased (aged 66) who were unhappy with treatment which he received from a Care Home in London from December 2018 to June 2019.
Briefly, the deceased had been discharged to the Care Home from hospital during December 2018 following back surgery. He had early onset dementia. He did not have any pressure ulcers at this time. The only wound he had was a surgical incision on his lower back following spinal surgery.
He was 6ft 1” tall in height and at risk of developing pressure ulcers (due to his cognitive impairment, his age and he was doubly incontinent). He lacked capacity and there was a Deprivation of Liberty authorisation in place.
At the beginning of April 2019, it is noted in his records that he had a skin tear on the sole of his right foot. A referral was made to the Tissue Viability Nurse (TVN). The wound was ungradable at this time.
At the beginning of June, he was readmitted to hospital with respiratory distress, a chest infection, sepsis and a Grade 4 pressure ulcer on his right foot. Sadly, he died at hospital a month later (July).
The family’s criticisms of Care Home
A Safeguarding report was prepared by the local authority which was very critical of the care which the deceased had received during this period. It identified a number of failings on the part of the staff in their treatment of the deceased whilst he was a resident at the Home.
The main risk factors were his bed was too short and there had been a delay in ordering the right size bed or a bed extension for him. There had been a breakdown in communication between the nursing team and maintenance team who should have placed the order. There was also evidence of a lack of regular repositioning/turning.
In light of this report/the care records, it was our case that these failings either caused or contributed towards his death in July 2019. In particular, the nursing and support staff at the home were negligent in that they:-
- Failed to put in place for the deceased a co-ordinated plan to ensure appropriate care to avoid pressure ulcers.
- Failed to put in place and follow a consistent turning regime.
- Failed to complete a Waterlow Risk Assessment on the deceased either prior to and/or after he became a resident at the Home.
- Failed to complete a Waterlow Risk Assessment or devise an appropriate Care Plan once the right foot ulcer had been noted.
- Failed to refer the deceased to a TVN for further assessment following her appointment in April 2019.
- Failed to monitor the pressure ulcer at each dressing change.
- Failed to heed the NICE Guidelines in relation to the prevention and treatment of a pressure ulcer.
- Failed to ensure the deceased was moved out of his bed at regular intervals to help relieve the pressure area – in particular, not using a wheelchair provided by the Hospital for this purpose.
- Failed to provide him with a sufficiently long bed for him to sleep in without the risk of a pressure ulcer on his foot and/or delayed in obtaining the right size bed for him following his admission to the Home.
- Provided inappropriate and ill-considered ad hoc care – we relied on the fact of a pressure ulcer progressing from an ungradable wound in April to a Grade 4 in June as evidence of sub-standard care.
Although the insurers of the care home acknowledged our Letter of Claim, they failed to respond within four months pursuant to the pre-action protocol for these type of cases. We then had to prepare this case for Court proceedings to include issuing a Claim form.
The insurers then appointed solicitors and the parties were able to negotiate a settlement. The Defendant acknowledged that but for the negligence, the deceased would not have died. The damages awarded included £20,000.00 for the injury suffered by the deceased prior to his death together with additional expenses incurred by the family to include his funeral expenses.
S J Edney Solicitors obtained damages for this client of £27,300.00 during 2021
Solicitor’s comment on pressure sore/ulcers
This was a tragic case. In our view, the deceased’s death could have been avoided if he had been provided with the right size bed on his admission to the Care Home.
Many older people in Care/Nursing homes and in the community will be vulnerable to developing pressure ulcers especially if they have mobility, cognition or nutrition issues which puts them at much higher risk of developing pressure damage.
This is well known to all Care/Nursing Homes and hospitals caring for older patients and those who also care for the elderly and disabled in the community.
With careful identification of risk factors and prompt interventions, in the vast majority of cases, these injuries can be avoided.
A pressure ulcer is an area of localised damage to the skin and underlying tissue caused by pressure, shear and friction and/or a combination of these factors.
The initial risk assessment carried out by a carer/nurse is crucial. A number of risk assessment models exist but the Waterlow system of scoring for risk is the best known and most frequently used.
The following steps should be taken to try and avoid these type of injuries:-
- Frequent moving of the patient to avoid ulcers as well as avoiding them lying in faeces and urine.
- Additional use of air mattresses or other mattresses, moved bed positions, sitting out of bed etc.
- Records should contain risk assessments, turning records, evidence of other preventative steps and, once an ulcer develops, wound charts and regular monitoring.
- Early referral for assessment by a Tissue Viability Nurse once an ulcer begins to develop is crucial.
- Early admission to hospital if the ulcer is continuing to deteriorate as the patient will be at a much increased risk of an infection/sepsis.
- As in this case, the right size bed and appropriate aids and appliances/equipment, like a suitable wheelchair, to minimise the risk of a pressure ulcer injury.
Lack of resources/staff is not a defence to a pressure ulcer claim.