Chief social worker issues guidance on adult safeguarding responses to pressure ulcers

Guidance includes assessment to guide professionals on when to raise pressure ulcers with adult social care services as a safeguarding concern

Image of computer key marked 'assessment' (Credit: momius / Adobe Stock)
(Credit: momius / Adobe Stock)

The chief social worker for adults has issued a national framework setting out when adult social services should consider holding a section 42 enquiry in response to concerns about pressure ulcers.

The guidance from Lyn Romeo highlights how hospital wards, care homes and other settings in England should respond when a service user develops pressure ulcers and when to refer the matter to local authority adult safeguarding services.

“Until now, there has been little, if any, consensus about the right agency, or multi-agency, response to identification of pressure ulcers,” Romeo said of the guidance.

“Pressure ulcers are truly dreadful for those who experience them – and distressing too for their families, friends and carers. The damage cannot be over-stated and they continue to be a major challenge for health and care practitioners across sectors.”

Adult safeguarding

“Most pressure ulcers are, in fact, preventable,” she added.

“But to prevent them we need to ensure all health and care professionals (including social workers) involved in the planning, commissioning and delivering of health and social care can spot the risks and take appropriate speedy action.”

The guidance says all instances of pressure ulcers should be reported to local health services even if the service user is receiving social care services.

It also includes an adult safeguarding decision guide for assessing whether the matter should be referred to the local authority as a safeguarding concern.

The decision guide assessment should be carried out within 48 hours of the ulcers being identified and should be completed by a registered nurse who has wound management experience and is not directly involved in the care of the service user.

Details about the size, location and severity of the pressure ulcers should also be recorded.

Section 42

The decision guide assessment focuses on a number of questions including:

  • Is there a concern that the pressure ulcer developed as a result of the informal carer ignoring or preventing access to care or services?
  • Has there been a recent change in the person’s clinical condition that could have contributed to skin damage?

If the decision guide assessment delivers a risk score of 15 or more, the incident should be referred to the local authority as a safeguarding concern. The local authority should then decide whether a section 42 enquiry under the Care Act 2014 is necessary before informing all agencies involved of its decision.

In cases where the decision guide risk score is below the threshold, the completed assessment and other records should be retained on the service user’s records.

Risk assessments

The guidance also says that risk assessments of care provided by non-clinical care workers need to address the likelihood of pressure ulcers developing and action taken to prevent ulcers from forming.

Carers should also be trained in how to prevent and spot pressure ulcers.

The Department of Health and Social Care says the guidance should be incorporated into local adult safeguarding procedures, quality standards and commissioning arrangements.

Pressure ulcers are estimated to occur in 4% of individuals admitted to acute hospitals and the NHS spends an estimated £1.4bn to £2.1bn a year treating them. No reliable data exists for how common pressure ulcers are within community settings.

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2 Responses to Chief social worker issues guidance on adult safeguarding responses to pressure ulcers

  1. Maharg February 1, 2018 at 2:02 pm #

    Though the information in this report reflects that staff both. social care and medical staff should be more proactive in managing or preventing damage, or evaluating what are the risks the reality safeguarding is that we are retrospectively into intervention, as we are only informed after the client has sustained pressure sore at grade three or above. We also may have ongoing concerns over care homes who regularly report, or having reported on, having individuals with pressure sores at Grade three.

    And though involvement from community Nurses or other health professionals can reduce or alleviate or even repair, tendency is that people sustain these injuries which may or may not be directly attributed to poor care ,and we are only notified once the injury has happened.

    Under safeguarding we have to try and draw a line at some point regarding the should be notified with, hence the reason why Grade three has been considered but obviously Grade three injury may vary its location and the impact that this has on the individual.

    I’m aware that nursing homes and residential homes are proactively in the interventions that they used to alleviate and reduce the potential risks, , however the additional factor of compliance of the person in care can be a difficult situation to manage. I’m aware of elderly individuals who are adamant to do what they want which has led to their skin integrity breaking down further. I am also aware of individuals who lack capacity and insight into the condition due to dementia who are not able to comply readily and willingly.

    There also may be a factor relating to changing overall health status which can be difficult to manage, and only can be chased after.

    Pressure sores may be indication to poor care, or lack of compliance to best advice, safeguarding sometimes has to identify severity of the injury and what can be done to improve or alleviate it happening again, but after it has happen, but that not good. for all.

  2. Roger February 1, 2018 at 10:14 pm #

    The reality of this is. ….in practice (the real world) District Nurses or TVN who are stretched to breaking point do NOT have time to complete separate visit to complete safeguarding paperwork.

    Try getting a simple continence assessment done…and see the delays this will incur.