12 Aug 2016 | Pressure Injury Prevention
John, a widower of 71 and recently retired, was admitted to hospital with an ischaemic leg. Prior to admission his mobility had decreased quickly over the last two days and he was unable to walk. He has a medical history of heart disease, peripheral vascular disease, diabetes and COPD, making him extremely susceptible for developing a pressure injury if timely prevention is not put in place. His words create the following story.
‘When I transferred to the hospital, I had to wait 36 hours in the emergency department before a bed was available. During that time, I was unable to move and became incontinent.
‘I told the doctors and nurses that I had a sore bottom but no one paid attention to it.’
John was admitted to the ward without a pressure injury risk assessment, and this was not completed until day four. The nursing notes stated that John had a reddened area on his sacrum. However, there is no record of a preventive intervention being put in place. On day ten, two days after his operation for a below-knee amputation, the sacral pressure injury was re-observed and documented as Grade III. Only at this stage was a pressure-relieving mattress ordered and a wound care specialist consulted.
The prolonged rehabilitation time caused him considerable pain and isolation. Reflecting on the ordeal, he said:
‘The wound itself was mostly numb due to it being so deep. I remember the smell from the wound, which was terrible. I found it embarrassing and did not want any visitors. The most disappointing part was not being able to get on with my rehabilitation following the amputation. It felt like my life was put on hold. At times I was frustrated and annoyed but put on a brave face for the staff.’
John’s case highlights how simple preventable action in the ED could have saved considerable suffering, and the importance of frequent assessment when immobile.
NB. Names and images have been changed to protect privacy.