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.

Source: CommunityCare