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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Fentons part of Slater & Gordon:- Exciting developments in spinal cord injury research

As a serious injury solicitor I have represented a number of clients who have sustained spinal cord injuries and have supported them through the court system. Beyond their injury, one thing which they have all had in common has been that having been told by their doctors that their paralysis is permanent, with the passage of time they have all adapted in a way which has shown off the best of human qualities. They have shown courage, dignity, adaptability and spirit to rebuild their lives such that they can rightly lead a happy, fulfilling and in many cases inspiring life.

But will specialist doctors who practice in the field of spinal cord injury always have to give such a negative prognosis to their patients? And will those who sustain spinal cord injury always have to face such devastating news about their future?

Recent research undertaken in the USA suggests perhaps not. The research which I am referring to has been in the press this month having recently been reported in the medical journal Brain.

In short, the research involved 4 paralysed participants who had complete spinal cord injuries ranging from C7–T5 and all of whom were at least two years post-injury at the time of the intervention. They each underwent epidural spinal cord stimulation and all demonstrated an ability to voluntarily move their hips, ankles and toes. They also displayed other improvements in their overall health, including increases in muscle mass and regulation of their blood pressure, as well as reduced fatigue and dramatic improvements to their sense of wellbeing.

The research has been described as groundbreaking. And although much further research must surely follow in order to bring real change to the spinally injured population at large, it challenges the belief that no functional recovery is possible.

And further, along with inventive and technical developments such as ReWalk, the exoskeleton mobility aid, research such as this must give hope to many that one day, they may be able once again to bear weight, balance and walk independently. And these developments will be all the more significant for future spinal cord injury patients.

As a lawyer who represents spinally injured individuals I keenly await yet further developments and must be vigilant as to whether progressive technology or treatment can benefit my clients. The law has it’s limitations but with the theory behind compensation payments being to put the injured party back in the position they would have been but for their injury (in-so-far as money can), surely these sorts of developments have the potential to help the law fulfil it’s own aim.

For more information about epidural stimulation studies and other spinal cord injury research,

please visit http://www.chartingourcourse.org/research/victory and/or http://www.christopherreeve.org/epi. For information about ReWalk please visit www.cyclonemobility.com/rewalk.

Will Cornwell – Fentons Solicitors (part of Slater and Gordon Lawyers)

Associate Solicitor

Email – will.cornwell@fentons.co.uk

Telephone – 020 7400 0225

Fentons part of Slater & Gordon: Will I , Won’t I? - The Importance of Making a Will

I just wanted to share with you something very tragic that happened recently.

One of our clients, whose claim for personal injuries sustained in an accident a few years ago and which settled at the end of last year, has sadly died suddenly.

He had sustained a spinal cord injury many years previously and the recent injuries had only served to make life that bit more difficult for him. The monies recovered through the claim were to assist in improving his quality of life and cover the cost of the additional care and equipment he was going to need in the future.

Our client was divorced but still on amicable terms with his ex-wife who was still involved in his day to day care. He had a daughter who he had not seen for many years and with whom he had no relationship.

During and at the end of the claim, it was suggested to our client that he make a will so that his estate would pass in accordance with his wishes in the event of his death. Unfortunately this never happened and he died intestate.

As his next of kin, his daughter now stands to inherit everything, including his house and the damages recovered from his claim, something which our client would not have wanted.

The importance of making a will cannot be underestimated. For very little cost, it ensures that provision is made for loved ones and monies and assets pass in line with the wishes of the person who has died.

Why let the law make this decision for you? Make a will now – before it’s too late.

For more information, please get in touch.

Deborah Johnson – Fentons Solicitors (part of Slater and Gordon Lawyers)

Principal Lawyer – Serious and Fatal Incidents

National Manager (Client Support Organisations) and National Practice Development Leader (Road Collision)

Email - deborah.johnson@fentons.co.uk

Telephone – 0844 854 3103

Planning for the unexpected: A Lasting Power of Attorney

A Lasting Power of Attorney (LPA) is a legal document which allows you to appoint somebody else, or more than one person (the attorneys) to make decisions on your behalf regarding property and affairs or your Health and Welfare. These are two separate documents so you can have either one or both types of LPA. A LPA is usually used if you lose the ability to make your own decisions (capacity). However an LPA can be used, with your permission, even if you can make your own decisions. This means that if you are having a long stay in hospital you can appoint an attorney to deal with your affairs on a temporary basis.

A Heath and Welfare LPA allows you to appoint an attorney or attorneys to make decisions about your Health and Welfare if you are unable to make the decisions yourself. The decisions can include life sustaining treatment, care regime and diet. Specific permission needs to be given in respect of life sustaining treatment. An attorney can only act under a Health & Welfare LPA if you lose the ability to make your own decisions and the form has been registered with the Office of the Public Guardian.

One of the main advantages of an LPA is that it is prepared while you still have capacity so you can decide who you want to be your attorney or attorneys. You can also put restrictions on the LPA clarifying or limiting the attorney’s powers to act. This means that you can plan ahead for a time when you may be unable to deal with your affairs. Your attorney is also answerable to the Office of the Public Guardian and can be prosecuted if they do not act in your best interests

If the worse should happen and you find you lack capacity either due to dementia, an accident or medical complication it is much easier for your attorneys to act quickly if an LPA has been done. If there is no LPA any potential attorney will need to make an application to the Court of Protection to be appointed as your Deputy. This can be quite a long winded process, it is expensive and you will not have any control over who your Deputy is. In respect of a Health and Welfare LPA it is reassuring to know that if a decision has to be made and you cannot provide consent the parameters of any decisions an attorney can make has already been clearly considered at a time when you can carefully decide what powers you wish to give an attorney.

Katie Pendower Fentons Solicitors part of Slater & Gordon Telephone number 0844 854 3198