Pressure sore - what should be happening?

[BunfightBetty]

DF 76 is largely bed/chair bound because of a normal pressure hydrocephalus that was misdiagnosed for three years (another story).

He has carers morning and night to get him out/into bed, washed and dressed etc, and DM looks after him the rest of the day.

Yesterday morning the carers mentioned he had a pressure sore and DM phoned the district nurses (who come periodically to deal with issues such as changing his catheter) to ask them to come out and assess the sore/start treating it. They failed to show yesterday and said they would come today. DM waited in today all day for them, but they have again failed to turn up and she hasn't had so much as a phone call to tell her what's going on.

I'm really worried that pressure sores can deteriorate really quickly and that this shouldn't be being left. Guidelines seem to say that if he was in a care home this should be assessed within 6 hours of being noticed, yet because my mum is struggling and just about managing at home he's been left for it to deteriorate.

What should be happening here? I will be ringing in the morning to try to chivvy things along, but typically the phone just rings and rings and nobody answers, or if you do finally get through to someone it's just a receptionist who passes on messages that they will come out and then they don't. Meanwhile it's likely getting worse and more complicated to treat.

Any help or advice would be much appreciated.

DN team should be seeing/overseeing and suggesting a plan of care.
He should be promoted to move or reposition as much and as often as possible by whoever can manage it.
Needs pressure relieving equipment such as cushion and mattress depending on where the damage is.

To add, whilst the care of pressure damage should lie with the dn team patients, family and carers can take responsibility for day to day care.
Self purchase a cushion and get him moving/relieving the pressure as much as possible.

Chase up the district nurse tomorrow.
Is the skin broken?
Medihoney is brilliant for pressure sores if you order some.
Where is the pressure sore?

Start by taking a photo of it so you know how bad it is now
Check him for any others - back, elbows, bottom, heels
He needs to be helped to move to get him off the affected area where possible and he'll need specialist pressure ulcer relieving equipment- mattress, chair cushion

They should provide a special mattress that ripples to increase circulation and encourage position changes

Who commissions the DN. GP Group? Ring them and put the delays in writing.

I would advise you to Google ‘Safeguarding Adults’ along with the name of the relevant local authority/Council where he lives to find information about how to raise a concern, and either ring the Safeguarding team or submit a form. They have a legal duty to deal with this as your DF is a vulnerable adult with care needs and it sounds like the District Nursing team are neglecting him. Agree with the practical advice from PPs too.

Thank-you all, this was just what I was hoping for - a mixture of practical advice and some help to put a rocket under backsides.

I’m two hours away from them, but will get on the phone to DM first thing and get her to check for any other sores and then start making the necessary phone calls to get them moving. The GP have authorisation from DF to discuss his care with me and were very quick to move last time I raised a concern about delays in treatment, so hopefully a mention of safeguarding should move things along. I was hoping there might be some guidelines on standards for how quickly they should respond, but what you’ve told me should be really helpful.

In my health board the duty of care is shared between carers and the DN team who caseload manage housebound patients.
In an ideal world it would be a "next available nurse" to assess but this is unlikely to be the same day and like most of the NHS community teams are stretched.
Pressure sores are graded, it may be that from the information the DN team received they triaged it accordingly (ie the skin is marking but not broken and that telephone advice such as barrier cream and repositioning was given until they can visit and assess.)
It is import and to identify the cause of the pressure damage.
Pressure wounds are avoidable and if your dad is unable to reposition himself then pressure relieving equipment should be in place as a preventative measure. (Cushion for chair, air mattress for bed etc)
Other areas to look at is he receiving adequate nutrition? The skin is our largest organ and it declines with age and disease.
Also remember that the carers are inspecting his skin daily and this is part of his skin care so it's very likely that this has been reported at a very early, reversible stage.

Don't buy the pressure equipment yourselves this will all be provided by the NHS.

Give the DN's a chase, if the skin has broken they should really have seen him by now. They should also do a full pressure check to see if any other areas of skin are at risk

Although it may sound counterintuitive, a regular brisk rub of any area at risk of pressure sores can help with prevention - because it's caused by lack of circulation, rather than the pressure itself. I wouldn't recommend doing it yourself without medical advice on the area with an existing sore, especially if the skin is broken, but it can help avoid the problem spreading.

It helps if your Dad even if bed ridden lies in a different position every 3 hours. Lie on left side then turn on to back then turn again on to right hip. If he's sitting he needs to stand if he can even if for a short while, or a mixture of sitting and lying down. He should change position every 3 hours to avoid pressure sores.

Thanks for your replied. DM spoke to the receptionist for the District Nurses this mri ing, before I could tell her I’d do it, and they said they were swamped yesterday but he is on the planner for today. I will be checking in and if they haven’t arrived by mid-afternoon I will be contacting his GP and raising a concern about this, mentioning safeguarding etc. Apparently, thr GP surgery did offer to chase up the nurses yesterday but DM told them not to bother as she’d ring them herself 🤦‍♀️

DM says the skin is broken and the site is about 1cm across. It was mentioned by the a carers on Friday morning but DM thought they should see how it went, so didn’t raise it with HCPs till Monday.

District nurse has been and dressed the sore. Apparently it is long and ragged, suggesting the skin has torn while he’s hauled himself up the bed. So the nurse gave advice on how to lie on the bed to avoid that and will visit again in two days. Also the nurse will order a cushion, but thinks a special bed isn’t required.

That's good that it has been caused by friction other than pressure, will be minimal depth to a friction wound and should heal up quickly for him.

That’s really great to know, thanks! Hopefully there will be no more of them and this one will heal up quickly.