Bolt Burdon Kemp: NICE publish new 2014 guidance on Managing and Preventing Pressure Ulcers

NICE is the independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health

This type of injury can have devastating repercussions and is a major concern for many who have catastrophic injuries.

I represented patients on the NICE panel tasked with drafting the recent guidelines, sharing with other people on the panel my knowledge on this area and ensuring the patient’s voice was both represented and heard.  I was well placed to do this, having had personal experience of pressure ulcers myself and also having achieved strong results for clients who have developed pressure ulcers due to substandard medical treatment.

In this article, I summarise the new Guidelines.

What is the purpose of the NICE Guidelines?

The guidelines offer best practice advice on the care of people with pressure ulcers.

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals.

What is a pressure ulcer?

Pressure ulcers are caused when an area of skin and the tissues below are damaged as a result of being placed under pressure sufficient to impair its blood supply. Typically they occur in a person confined to bed or a chair by an illness and as a result they are sometimes referred to as ‘bedsores’, or ‘pressure sores’.

Who is at risk? 

Although pressure ulcers are more likely to occur in people who are seriously ill, anyone can develop a pressure ulcer at any time therefore all patients are potentially at risk of developing a pressure ulcer.

How are pressure ulcers caused?

It is acknowledged that pressure ulcers are more likely to occur in people who are seriously ill, have a neurological condition, impaired mobility, impaired nutrition, or poor posture or a deformity. Also, the use of equipment such as seating or beds which are not specifically designed to provide pressure relief, can cause pressure ulcers.

As pressure ulcers can arise in a number of ways, interventions for prevention and treatment need to be able to be applied across a wide range of settings including community and secondary care.

Are pressure ulcers preventable?

Pressure ulcers are often preventable and their prevention is included in domain 5 of the Department of Health’s NHS outcomes framework 2014/15. Its implementation will ensure practice is based on the best available evidence. 

Pressure Ulcers are not as yet considered to be a ‘Never Event’ but there are many who are of the view that they should be considered as such.

How can pressure ulcers be prevented?

The Guidelines make recommendations for the prevention of pressure ulcers to include methods for risk assessing and identifying pressure ulcers, as well as specific preventive measures that should be applied, such as the use of appropriate pressure relieving devices. The Guidelines also consider the treatment and management of pressure ulcers which include recommendations on wound care, adjunctive therapies and support surfaces. While there is much clinical expertise and good practice focused on preventing and treating pressure ulcers, it is hoped that this evidence-based guidance will contribute to reducing the number of pressure ulcers nationally through its implementation throughout the NHS.

Adult and paediatric healthcare teams should work jointly to provide assessment and services to people at risk of developing or who have developed pressure ulcers. Diagnosis and management should be reviewed throughout the time care is provided, and there should be clarity about who is the lead clinician to ensure continuity of care.

Who does the Guidance apply to?

The Guidance covers prevention and treatment and applies to all people in NHS care and in care funded by the NHS.

It can also be used as a best practice guide for anyone providing care to individuals who are at risk of developing a pressure ulcer.

Responsibility for implementing the Guidance

Healthcare professionals are expected to take the guidance fully into account when exercising their clinical judgement. Implementation of the guidance is the responsibility of local commissioners and/or providers.

Commissioners and providers are reminded that it is their responsibility to implement the guidance, in a local context and in light of their other duties.

I do really hope that the new guidance will enable healthcare practitioners to identify more readily where a patient is at risk of developing a pressure ulcer so that active steps can be taken to stop this from happening. I would also hope that where pressure ulcers do develop, they are spotted quickly and properly and effectively managed to ensure the best possible outcome for the patient.

The new NICE guidelines can be found here.

I offer not only legal expertise but also unique understanding of what it is like to have a pressure ulcer. Contact me here to discuss your case further. Alternatively call 0808 1596 222 or contact us online.

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