Scottish clinical guidelines on patients’ pressure ulcer care published

By John Tingle

Failures in assessing the patient properly for pressure ulcers can result in adverse incident reports, complaints and even litigation. A look at medical malpractice lawyer web sites in both the UK and USA will reveal a number of attorneys offering specialism in pressure sore litigation and publishing compensation awards. In the NHS poor pressure area care is a key patient safety issue and positive steps have been taken to reduce the occurrence of these incidents which can cause result in severe harm and even death to patients. The incidents also cost healthcare services a lot of money in remedying the problems of neglect.

The problem of poor pressure area care can also be seen in other countries. Health is a fairly generic concept, whilst the context of health care may well be different, valuable patient safety lessons can be learned from looking at the health quality reports of other countries. Developing an informed comparative patient safety perspective to issues can save both time and money by not reinventing the wheel.

There is new guidance from Scotland, Healthcare improvement Scotland (HIS) on the prevention and management of pressures ulcers which will be of interest to nurses and all those concerned with health quality and governance.

It is clear from reading the literature on pressure area care that most pressure ulcers are preventable. NICE ,The National Institute for Health and Care Excellence which provides national guidance and advice to improve health and social care state:

“Pressure ulcers can result in severe harm or death and research suggests that between 80-95% are avoidable. Pressure ulcers are also a key patient safety concern. In relation to the National Reporting and Learning System (NRLS) a review of death and severe harm themes undertaken in for 2011/2012 demonstrated that pressure ulcers were the largest proportion of patient safety incidents accounting for 19% of all reports.” (p3)

It is clear that lessons are not being learnt about pressure area care and major patient safety problems are highlighted. If we then add to the mix the fact that most of these incidents are preventable and that they have caused in some cases severe suffering and death then this will set alarm bells ringing for patients, relatives and their lawyers.They will all be asking questions about whether negligence has occurred and could well be contemplating legal action to recover compensation. Pressure ulcers can be fairly easily avoided and more reflective care practices can be seen to be needed in this area of care.

The Scottish guidance

There are 6 standards in the Scottish guidance:

Standard 1: Leadership and governance

Standard 2: Education, training and information

Standard 3: Assessment of risk for pressure ulcer development

Standard 4: Reassessment of risk

Standard 5: Care planning for prevention and treatment

Standard 6: Assessment, grading and care planning for identified pressure ulcers.

The standards begin with a standard statement, rationale, and then criteria. There are also headings covering:

What does the standard mean for you as a person receiving care?

What does the standard mean for you as a member of staff?

What does the standard mean for the organisation?

Followed by practical examples of evidence of achievement.

The guidance is comprehensive, thorough and clear and hopefully will reduce the incidence of pressure ulcer development.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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