Pressure sores from the sharp end

Pressure sores from the sharp end

Award-winning Times columnist Melanie Reid has written this article for Independent Living about the ever-present risk of pressure sores for everyone with limited mobility.


When I started going to the gym in the spinal unit, in a wheelchair I could barely push and bewildered by everything around me, I heard a conversation repeated among the physiotherapists:


“Where’s X this morning?”


“He’s got a mark.”


X would duly not appear. I’d hear the nurses, too, behind thin curtains, saying: “Let’s have a look at your mark.”
 

The mark of doom


I didn’t have a clue what it meant, but the doomy way they said it made me think of Treasure Island, and old Blind Pew tapping his way up the street to deliver the black spot to someone, that dreadful message of impending death.

Nor did I understand why my time in the wheelchair was strictly limited, built up slowly according to strict protocols. It took several weeks to reach “up as able”, which meant I could stay sitting all day.


Later, when our heads were clear of morphine, everything began to make sense — the tilting beds, the pillows stuffed in our backs to make our paralysed bodies sleep on either one hip or the other, the nocturnal visits to be “turned” – put onto the other hip – on a strict four hour protocol.

It was all about protecting the skin on our backsides.
 

First sign of a dreaded pressure sore

A mark was the first sign of a dreaded pressure sore.



With the loss of mobility, I had joined the many thousands of people whose skin is forever compromised by immobility. Whether elderly and unable to get up and move around, or badly injured and stuck in a wheelchair, our buttocks were having to do a job they was not designed for – carry the bulk of our body weight. They’d taken over the role of the soles of our feet.


Later, in skin management classes , we learnt about the precise horror of getting a sore — how, ignored, they could reach the size of dinner plates, and go right to the bone, requiring to be packed daily and taking up to a year in bed to heal. They were a prison sentence; in some cases a death sentence.
 

Testing for damage every single day

One poor soul in the spinal unit spent her time cocooned upon a bed the size of a small car, a strange, hot presence which hummed all night. She’d been paralysed years before but had developed a terrible pressure sore on a buttock, and had been readmitted to spend months on a platform of shifting warm sand, allowing it to heal.

Even as I was drilled in how to pressure relieve by lifting myself a fraction, every so often during the day, my husband and future carers learnt to examine my buttocks pre-emptively.

They learnt to test by “blanching” – if, when you pressed on a mark it disappeared, then it wasn’t too serious. If it didn’t, then the sub epidermis was damaged and you were in trouble and confined to bed.

We were given mirrors on bendy handles so that we could check for ourselves, and drilled to ask our carers to plump up the gel in our wheelchair cushions every morning.


So checking my buttock skin became second nature, just one more element to the daily hard work of managing a paralysed body.
 

Pressure sores are avoidable…

I think the important point is that with proper management, as practised like this in spinal units, then pressure sores are entirely avoidable. It just takes time, attention, knowledge and equipment.

There is no excuse for anyone, in either hospital or nursing home, to get these sores. But they are horribly common because resources are in short supply.

Pressure ulcers are the most reported cause of harm in the NHS. Depending on which NHS figures you choose, treating pressure damage costs from £1.4m up to £3.8m per day, and between 1,300 and 2,000 patients per month develop pressure ulcers in hospital.

NICE says new pressure ulcers are estimated to occur in 4–10% of patients admitted to hospitals in the UK and the rate is unknown in the community and care homes.

Their presence has been associated with a two to four-fold increase in the risk of death in older people in intensive care units.
 

Education and awareness are also key

The NHS’s ‘Stop the Pressure’ campaign in England has helped – a 50% reduction in some areas – by raising awareness of the causes of pressure ulcers via an extensive communication strategy, understanding the early warning signs, taking preventative measures and following protocols.

But surely technology can do more?

Ten years ago, in the spinal unit they had a chair with a pad on it, to read where you put the most pressure. I tried it and it was horribly clear that my left buttock was a hot spot, glowing red like a thermal camera, because my pelvis was twisted in my chair. Unconsciously I now shift and lean to my right every chance I get. Knowledge is power.
 

New development could be a sea change

Technology is improving specialist pressure mattresses and gel cushions all the time. But there is one other breakthrough which looks as if it could revolutionise pressure sore prevention.

It’s the SEM Scanner, which has been trialled by the NHS and which NICE agrees can detect early signs of tissue damage and could offer resource benefits by avoiding hospital-acquired pressure ulcers.

The SEM Scanner, which costs £5,800 plus VAT, is an early warning to show skin under the surface is breaking down from pressure.

It’s a hand-held, wireless device which alerts medical staff to the areas of a patient’s skin which are in danger of pressure ulcers – up to five days before they become visually apparent. Such early detection is key to prevent tissue damage.

So far it’s been trialled in more than 20 different healthcare facilities, including Stroke/Rehabilitation (but not specifically spinal units yet), as well as Medical, Orthopaedic, Elderly Care, Intensive Care, Vascular Care, End Of Life Care, Surgical and Renal.
 

Results are hugely encouraging

Virgin Care experienced a 95% drop in the pressure ulcer rate during an evaluation at Farnham Community Hospital in Surrey.

Marie Curie, Newcastle, revealed a 47% reduction in hospice acquired pressure ulcer incidence rate in the first six months of use (November 2017 – April 2018).

I hope the NHS sees the cost effectiveness in early intervention.

Think of the misery and pain such scanners would prevent. Over the years, I’ve had some partial return of feeling. This means a deep ache in my left buttock which by the end of the day can drive me to desperation.

A friend of mine from spinal unit days, similarly blighted with incomplete paralysis, is in such pain from his buttocks that his only respite in the evening is to sit upon a doughnut cushion, like a woman who has just given birth.
 

Pain with a purpose

But remember, knowledge is power. The pain, although unwelcome, is also a blessing, a sore early warning that breaks past the paralysis and tells me, time to change position.

It was pain that told me when the gel on my specialist J2 gel cushion needed to be replaced, several years after I left the unit.

Without it, I wouldn’t have known the gel had failed.



My left buttock, however, has no feeling in. I don’t know whether it’s under acute pressure on not; I have to guess and pressure relieve.

I’d like to think that when I’m much older and can’t manage my own care, a scanner could be in every hospital, potentially to keep me and many others alive and out of misery.
 
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Further reading and resources

Melanie Reid writes the Spinal Column in The Times Saturday magazine every week. She has also written a wonderful book, The World I Fell Out Of, which is utterly compelling and should be required reading for anyone who doesn’t know what the future holds for them – which is all of us. (external link will open in a new browser window)

Ambre-Stone has launched Tidewave, a unique new solution to pressure sore prevention and treatment

Event rider Saffron Cresswell also broke her back in a fall from her horse – she got home from hospital more quickly thanks to a temporary wetroom installation

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