lack of knowledge among nurses is
undoubtedly a factor, with gaps in
post-registration education and the
difficulty of obtaining time off for
study leave particularly to blame.
Another huge issue that features
in many cases is documentation,
where clinicians had failed to record
the steps they took to prevent or
manage ulceration (‘Pressure ulcers,
negligence and litigation’—
Wounds
UK
). There is also confusion around
what represents an‘avoidable’ or an
‘unavoidable’pressure ulcer, with
legal opinion generally following that
if action was not taken to prevent an
‘avoidable’pressure ulcer, then an
element of negligence is involved.
The recent NHS Patient
Safety First campaign (www.
patientsafetyfirst.nhs.uk) stated
that an avoidable pressure ulcer is
where ‘the person receiving care
developed a pressure ulcer and the
provider of care did not do one of
the following: evaluate the person’s
clinical condition and pressure ulcer
risk factors; plan and implement
interventions that are consistent
with the person’s needs and goals,
and recognised standards of practice;
monitor and evaluate the impact
of the interventions; or revise the
interventions as appropriate’.
In the future, what is important
is that nurses not only understand
the clinical implications of pressure
ulceration and how it develops
— can you tell the difference
between a category two and four
ulcer, for example? — but also the
legal implications of an area that
is putting wound care clinicians
increasingly under the spotlight.
What many of you will want to
know is — ‘Can I be liable?’While it
is unlikely that an individual nurse
would ever be held liable for the
development of a pressure ulcer
due to the difficulty in apportioning
personal blame (‘Pressure ulcers
and litigation’—
Nursing Times
),
WOUND CARE TODAY
2015,Vol 2, No 1
7
WCT
Some district nurses across the country are beginning to feel demoralised
every time a patient on their caseload develops a category three or four
pressure ulcer, thereby requiring them to attend a ‘safeguarding vulnerable
adults’ meeting and a case conference. This is despite the fact that in most
instances there are no safeguarding issues involved with the development of
the pressure ulcer and, if there were any, the attending district nurses would
have highlighted them.
Edwin T Chamanga,
Tissue viability service lead, Hounslow and Richmond Community Healthcare NHS Trust
WOUND WATCH
i
it is still important that nurses
understand best practice and how
to implement it, as well as following
some basic rules:
i
Use recognised pressure ulcer
assessment scales and always
perform skin assessment
i
Always try and follow local policy
— if you can’t, make sure you
record why not
i
Document any discussions with
other practitioners
i
Record any clinical changes,
particularly in the skin
i
Record any interventions, such
as turning or dressings applied
(‘Pressure ulcers, negligence and
litigation’—
Wounds UK
).
While it is unlikely that any of
us are going to end up in court any
time soon, the litigation bill for
pressure ulcers is rising fast. We
owe it to ourselves and our patients
to be mindful not only of the
financial cost of these wounds, but
also the impact on the health and
wellbeing of our patients.
Every nurse will be aware of being under the pressure ulcer spotlight. While the
emphasis from organisations is often about robust data collection and accurate
reporting, the frontline nurse wants to ensure that they prevent patients from
sustaining an ‘avoidable’ wound. The reality is that pressure ulcer prevention is
relatively easy to achieve if we are given time to nurse our patients instead of
repeatedly ‘ticking boxes’ to comply with policy. Some patients will need more
support than others. As nurses we should be establishing patient need and risk
based on professional judgement and act accordingly.
Michael Ellis
, clinical nurse specialist in tissue viability; lecturer in healthcare practice,
Royal Devon and Exeter NHS Trust
