When the Safety Net Fails: A Case Study in Geriatric Wound Care

An 89-year-old man suffers a severe fall, receives 12 stitches in A&E, and is sent home at 4:00 AM with bleeding dressings and instructions to find his own follow-up care. But when he tries to book an appointment, his GP surgery, local hospital, and district nurses all say they are completely full. Independent nurse Christine Talbot shares what happened when she stepped in to treat his wounds, and why the system's failure to coordinate basic care is putting vulnerable patients at risk.

An eighty-nine-year-old gentleman with a long history of arterial disease in his right leg whom I have been treating since 2018 for severe trauma related, surgically induced lymphoedema to his left lower leg, has now been diagnosed with significant arterial disease in his left leg.   Mr M is undergoing various tests and scans to assess his medical suitability for a femoral ablation to  the left leg.

All elective appointments and procedures are privately funded entirely by Mr M including GP appointments, on occasions certain tests are conducted by the NHS at his local GP practice.

Eight days ago, returning home from one of his many appointments, Mr M slipped  badly  on the front door mat when entering and fell badly seriously injuring his right arm, causing  a long deep cut to the lateral forearm and a nasty  wide skin tear below the elbow.  Mr M bleeds very easily more so as he takes Aspirin, the wound was pouring blood, and the forearm skin had flapped back.

As the incident occurred early evening neither Mr M’s surgery nor local hospital were open, he took a taxi to his main hospital at a charge of £64.  Eventually Mr M was seen by a nurse and triaged, removing the dressing to view the wound and replacing it with the same.  Eight hours later at 4.00am Mr M was discharged, the open wound had been sutured with twelve stitches and sticky plasters applied to both areas, no form of compression or stockinette was considered.  Mr M was instructed to make his own arrangements for a dressing change and removal of sutures within seven to ten days.   The return taxi fare was £77 as it was out of hours.

Mr M made every effort to arrange for a dressing change and removal of his sutures but neither his GP Practice, his local hospital, nor the District Nurses were able to offer appointments.  Mr M contacted me to change his dressing.  I was appalled by the very minimal, inadequate, heavily blood-soaked dressings leaking out blood and serous fluid, the elbow wound had dead skin hanging off, this moist medium was ripe for systemic infection Mr M had already had two episodes of Cellulitis in the lymphoedema leg, one only  very recently. 

I thoroughly cleaned the arm wounds cutting off loose dead skin hanging from the elbow graze, gauze pads applied, arm bandaged with Urgo light short stretch and Comfifast stockinette applied to the arm, not only to protect the wounds but to try and reduce some of the limb swelling and to settle any further tape allergy. Briefly applied the QWL laser and redressed both areas.  I agreed to remove Mr M’s twelve stitches.  

Mr M had fallen onto his left buttock area, the extensive contusion to his left buttock was shocking, this has now spread to the whole of his backside and up into his lower back.  On day eight as asked, I removed the stitches which in parts were heavily congealed into the scar but all twelve were successfully removed.

A&E have not informed Mr M’s GP surgery of his accident and the current status of his injury, perhaps that is another administrative cut back.  It is fortunate with my medical background I am able to treat and manage all the infection and injuries and to offer both professional knowledge, advice and support at any given incident which befalls Mr M.  

It is fortuitous I have treated Mr M’s lymphoedema for the last eight years and therefore am familiar with any alteration to his well-being.  Mr M is truly thankful I am contactable at any given time to support and guide him through medical mishaps, poor practice, and current social age devaluation; he does not know what he and his wife (who herself is unwell,) would have done without such reliable backup.  

Christine Talbot SRN MLD DLT

Read more case studies from Christine Talbot