pressure sores from labour

[Solmum2b]

Hi, recently given birth to my healthy son. However, I am on evened by the care provided by the hospital. I developed three pressure sores while in labour which are still healing 3 weeks labour. I left the hospital with only a cotton pad covering the wound. It has since required daily dressings from a district nurse. Is this malpractice?

[Girliefriendlikesflowers]

A necrotic pressure sore would be a grade 3 possibly grade 4 pressure sore - I'm a community nurse. Am shocked this has happened, you definitely need to complain. I imagine the community nurse team that are visiting you will have completed an incident form as well, we have to report every pressure sore over a Grade 2 even if not acquired in the community setting. link on grading

If it were me I would be speaking to a legal person about filing a claim for compensation, the additional discomfort and time spent at home recovering should be compensated for!

[krazipan]

If you have developed a necrotic pressure ulcer during labour then I would definitely complain! For a category 4 pressure ulcer it would have to be down to bone/muscle etc (underlying structures). It sounds more likely to be a category 3 pressure ulcer, but this is still classed as a serious incident and reportable outside of the trust.

[Solmum2b]

This is currently what it looks like

[Solmum2b]

This is 3 weeks since I gave birth

[krazipan]

I would say that is a category 3 pressure ulcer. If that was me a very big complaint would be going in. Nobody should ever get a pressure ulcer like that!

[Solmum2b]

Thanks krazipan- I do want to complain. But I also really just want to get better fast! Pressure and newborn baby does not make it easy to sleep ;(

[krazipan]

The best thing you can do solmum is keep pressure off it now as much as possible, eat and drink well and keep it clean and dry. All of which, I'm sure you are already doing. It looks to be healing, once the necrotic centre has come away it should heal fairly quickly. Hope it's better soon

[lljkk]

Do pressure sores typically need 3+ weeks to heal, or could they still be at Stage 3-4 even after 3 weeks & daily dressing changes?
Is it possible they are infected with something else she picked up in hospital?
My grandmother had quite a few, but she was very frail, hours she couldn't move, etc.

[krazipan]

Pressure ulcers can take weeks to heal. They need to debride (clean up), granulate before epithelialisation (new skin growing and healing). 'Superficial' ulcers can heal quicker but healing is affected by nutrition, other conditions such as diabetes, infection etc.

[krazipan]

Just looking at the pictures they don't appear infected.

[RoseDeWittBukater]

I can't believe the hospital aren't investigation this already?? I work in this area and we recently had a similar report that has been treated as a serious incident and is being investigated accordingly. The patient has been kept informed at all times, as you should be. You should absolutely take this further, if the hospital haven't instigated an investigation themselves they're being horrifically negligent.

[GraysAnalogy]

To stage an ulcer you MUST be able to see the base. You should never grade a pressure sore that has eschar because you have absolutely no idea what's under that necrotic tissue. Could be a sinus for all we know so that's why TVN's and current best practice says don't stage a necrotic ulcer. It is very likely to be a stage 3 or 4 but you can't commit to that because of the disparity there may be when the necrosis comes away. You may have documented as a stage 3 but when that eschar comes away you may have a stage 4 on your hands. You can't grade what you can't see.

Wound Care Essentials: Practice Principles states this books.google.co.uk/books?id=qxMXba1uRHkC&pg=PA268&lpg=PA268&dq=can%27t+grade+necrotic+ulcer&source=bl&ots=oU3OPfZdpA&sig=cPAKdAwKK7xc2N4WUtLMiwC8o8s&hl=en&sa=X&ved=0ahUKEwjxyYfrtfDLAhXIApoKHUceCdwQ6AEINjAE#v=onepage&q=can't%20grade%20necrotic%20ulcer&f=false

As does woundcareadvisor.com/pressure-ulcer-staging/

and www.woundsource.com/patientcondition/pressure-ulcers-unstageable


Necrotic ulcers used to be classified as stage 3 or 4 but best practice has now changed and says to state 'unstageable'.

[GraysAnalogy]

Pressure ulcers can take MONTHS even years in some cases to heal. In a healthy individual such as OP I would expect weeks-months.

[WhoTheFuckIsSimon]

Thanks Grays. Nhs choices need to update their website.

Hopefully as a midwife I never come across a necrotic pressure sore.

[GraysAnalogy]

I think NHS site simplified a bit, you would definitely get necrosis (tissue death) in a grade four but you wouldn't get full thickness necrotic eschar. It's due for updating this year apparently that page so hopefully it'll include unstageable this time round ha.

I hope you don't too, I've seen some horrific sites that have made me so absolutely angry and upset because they were entirely preventable.

[RoseDeWittBukater]

The case in my trust has been the first midwifery pressure sore it's been aware of within this trust and no other trusts asked have had any stage 3/4 ever either. It's incredibly rare, and rightly so!

[Girliefriendlikesflowers]

Do you know what they are dressing it with? I would hope they are hydrating it to try and get the necrotic tissue to lift? A good tissue viability nurse may be able to surgically debride some of the dead tissue, once the necrotic tissue has lifted it should heal quite quickly.

Have you been checked for diabetes? Do you smoke?

My dd was in PICU a couple of weeks ago with breathing problems, she is normally a fit and well 10yo. After 24 hours being intubated she had grade 1 damage to both her heels it is shocking how quickly skin can break down.

[lougle]

Goodness, I'm shocked. Pressure ulcers are serious incidents and we report any grade 2 and above PU via Datix (the NHS reporting system). We also report PU we discover on admission. In part to be able to prove that we didn't cause the PU on our unit (ICU). In ICU we turn our patients 3 to 4 hourly and we document our assessment of all pressure areas when turned (shoulder, spine, elbows, sacrum, knees, heels). It really is taken as seriously as their ventilation or nutrition.

Are you having any Intrasite gel (or similar) applied to encourage the necrotic tissue to break down?

[Solmum2b]

I don't smoke, or have diabetes. I have enjoyed the odd glass of wine now I'm not pregnant ( please tell me this is ok) otherwise I am a healthy 33 year old (11 stone 5ft 8- pre pregnancy) so not over/underweight.

Really appreciate all the comments and links. I have had 'inadine' patches applied and its washed with saline solution. They also apply some kind of gel which is supposed to lift the black bit off. I also have a memory foam pillow to sit on. I think (now that the district nurse is involved) that I am getting the care I need. But it's helpful to hear the thoughts of other midwives. I thought it wasn't right at the time, and now I have had my suspicions confirmed.

Is there anything else I can do to heal faster?

[mayhew]

That is bad in a young healthy client. I've seen two maternity pressure sores but yours is worse.

Definitely complain.

[Girliefriendlikesflowers]

They shouldn't be putting inadine on it yet, something like flaminal hydro would be more appropriate and then a foam based dressing over the top. Once the necrotic bit has lifted, if it looks clean and is granulating underneath then inadine would be o.kay.

Other than staying off of it, eating and drinking well plus a multi vitamin not a lot more you can do really. Good that they have got you a cushion to sit on.

Its definitely not right and could have been avoided, thats said I do think you have been very unlucky as well.

[GraysAnalogy]

I wouldn't have said inadine either, hyrogel, possibly a Medihoney patch for debridement.

Are you breastfeeding? Inadine shouldn't be used on breastfeeding women.

Unless it's visibly dirty it doesn't need to be cleaned with saline either unless you prefer it to be that is.

Like others have so rightly said there's not much you can do except eat and drink well and relieving the pressure. The only way you'd get that healing more quickly is it it was sharp debrided (cut the eschar- black tissue off) which they don't do all that often anymore.

Feel really bad for you because this was entirely preventable :( please do take it further

[NotnowNigel]

Gosh Solmum2b you poor thing. It's the last thing you need when you're trying to adjust to life with a newborn, particularly after such a tough birth.

I'd definitely get some legal advice. It's alright saying you don't want to sue, but sometimes that's the only way to get them to take the issue seriously and put protocols in place to prevent this happening to anyone else. And this is very preventable and is really just basic nursing. |Deplorable care.

What hospital did this happen at?

[NotnowNigel]

And to answer your original OP - yes it is very definitely malpractice. I'm angry for you.

[Solmum2b]

Borders general hospital- Melrose :(