Development and deterioration of pressure sores in elderly patient

Our clinical negligence team was instructed by the family of an elderly lady who died in August 2019. Prior to her death she was admitted to hospital, during which time a significant pressure sore developed and deteriorated.

Our client, Mrs W, was 87 years old when these events occurred. She lived in supported accommodation but was independent with all day to day tasks. She was admitted to hospital in May 2019 due to feeling generally unwell as a result of a urinary tract infection. She was treated for possible sepsis. On arrival to A&E a body map was completed which recorded a moisture lesion on her sacrum. However, Mrs W was not transferred onto an air mattress until the early hours of the following day.

Within two days of her admission, Mrs W was noted to have a grade two pressure sore on her mid buttock. By the next day, this was recorded as a category two pressure sore on both buttocks and the sacrum.

Despite the development of the grade two pressure sore, and the fact that Mrs W was noted to be at high-risk of developing a pressure ulcer, the pressure care she received was poor. The medical records demonstrate various points where the pressure care was not completed; for example, two to four hourly turning was supposed to take place, but there was no evidence that it did. There was evidence in the records that on particular dates, Mrs W was left on her back for up to eight hours without any repositioning.

Mrs W made good progress in respect of her treatment for sepsis; she was able to engage in physiotherapy and while she had not recovered to her baseline, towards the end of May she was deemed fit for discharge.

She was also referred to the tissue viability nurse at the end of May, by which stage, the sacral sore had deteriorated to the extent that it was unstageable. However, on assessment a couple of days later, Mrs W’s prognosis was deemed too bleak, and the sacral sore had deteriorated further.

Mrs W was discharged to residential care in early June 2019 with a grade three sacral pressure sore. The sacral wound continued to deteriorate further, despite intervention from a tissue viability nurse, causing Mrs W significant pain requiring morphine. She passed away in early August 2019.

The post-mortem report noted the sacral pressure ulcer as a condition contributing to the death.

The defendant hospital trust completed a Serious Untoward Incident investigation report which focused on the care provided during Mrs W’s hospital admissions and the development of her pressure sores. The report acknowledged that Mrs W was left on an A&E trolley for nearly eight hours, and that this may have contributed to her moisture lesion developing into a category two pressure ulcer.

The report further noted periods where Mrs W was nursed on her back for eight hours without repositioning. Failings in completing repositioning charts were also noted within the report.

An inquest into the death was opened and the coroner concluded that Mrs W had developed a category three, or unstageable, pressure ulcer during her stay, as a result of the omission of regular turning.

As part of investigations into the clinical negligence claim, we arranged representation from counsel for the family at the inquest. This was an extremely upsetting case for Mrs W’s family, who witnessed her deteriorate as a result of the sore and spend the remainder of her life in residential care, experiencing significant pain.

Expert evidence was obtained which confirmed that poorly documented skin checks and a lack of repositioning, especially during Mrs W’s initial time in A&E, plus the lack of good wound management on the ward, resulted in the development and deterioration of the sacral pressure sore. Furthermore, Mrs W’s nutritional deficit was not addressed, and no dietician input was sought, despite concerning MUST scores. It was also confirmed by the claimant’s experts that the sores contributed to Mrs W’s death.

A letter of claim was sent to the trust and, in order to try and conclude matters for the family, an offer of settlement was made at the same time. In response to the letter of claim, liability was admitted by the trust. However, while it was conceded that the admitted breaches of duty led to the deterioration of the pressure wound and contributed to Mrs W’s general debilitation, and additional pain and suffering prior to her death, it was denied that the pressure sore caused Mrs W’s death.

Despite the denial of causation, settlement negotiations continued, and the claim was subsequently settled for an undisclosed sum.

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