Nappy rash / pressure sore?

Lack of staff, lack of attention, lack of adequate continence care has resulted in Dad suffering a large ‘welt’ between his buttocks. Obviously I shouldn’t have seen this but because I end up doing most of his care I have. I drew their attention to it and they said they’d find a ‘lolly pop stick’ which is apparently some kind of barrier cream. Except that nobody could find any, not even on the other wards. I couldn’t check yesterday but I had another look today because Dad was complaining about it again and it is now leaving a corresponding patch on his pad. I again drew it to their attention and they again told me there was no barrier cream in the hospital. I asked if it should be dressed and they said no, it needs to be checked on and that can’t be done if it’s dressed. Bearing in mind he has a chest infection, an ear infection & he is trying to get out of hospital, I’d really like to avoid another infection and I think they should be doing something more than applying emollient to it. It’s a wet wound and it’s frequently exposed to urine and sometimes faeces. It’s not going to heal using a product that’s going to make it more moist is it? Any ideas what they SHOULD be doing?

Hugs. Perhaps try gentle threats.

In a way, Thara’s suggestion is appropriate…ask to speak to the skin integrity nurse at the hospital (not all hospitals have one, but quite a few do), and failing that ask to speak to the hospital’s safeguarding team. Pressure sores at that level are a sign of neglect. Make sure you also notify your MP…

The MP for the hospital area is Penny Mordaunt…

I’m right though aren’t I? It won’t heal with an emollient?

As far as I know, emollients aren’t used for pressure sores, but I have no direct experience. This link is really useful as it’s the NHS take on treating pressure sores. I think it backs you up. Pressure ulcers (pressure sores) - Treatment - NHS

Henry’s Cat,

your poor Dad.

Pressure sores are reportable to the CQC once they get to a certain severity and hospitals are supposed to have systems in place to prevent them. Clearly this isn’t happening due to all sorts of reasons.

If he needs a lolly pop stick I think they mean a Debrisoft Lolly, and there are non in the whole hospital … then the ward doctor or prescribing nurse should be requesting them from the hospital pharmacy or whoever is responsible for ordering them if they are not patient specific.

If the hospital don’t have a skin integrity nurse, I think I would contact PALS or someone higher up in the hospital.

Sending cyber support.


Thanks both. I asked again about a barrier cream and was again told there was none in the hospital. I said I’d probably try and get hold of the skin integrity team to see what they advised instead as I’d managed to find out they had a department for this on the website. They don’t work weekends of course. The nurse went off to see what his prescription was for this apparently - I’d be very surprised if there was any such thing.

I started to do my usual ‘move him up the bed’ thing, as I try and get there in time for a meal so need him to bending in the right place for the bed. This was much to the alarm of the HCA & nurse in the room who I hadn’t met before! I asked to have a look at his wound (not really sure if it counts as a pressure sore or not because it’s not from pressure, just from urine contact). She said it was drying it, it clearly wasn’t & it was worse - bigger and weepier, and Dad was begging them to put something on it because it was so sore. She went off to find something to put on it and low and behold came back with 3 packets of the special barrier cream! I can’t recall what it was called but I’ll make sure I make a note tomorrow. Apparently there are shortages with various things like this across the hospital but she couldn’t say if it was a nationwide thing or not.

I don’t know what they mean by a lollipop stick as I just looked up the debris off it the wound doesn’t look like it needs debriding etc, just covering to protect it from more urine. They said it was something to do with evaporation & trapping moisture. Hopefully this stuff will do the trick anyway. Thanks so much for your advice!

Is it Cavilon?

Yes agree with Greta. Could it be Cavilon? My medically non compliant husband has those daily. They are very good and his sores are much better - almost healed although skin very delicate in places. I would be amazed if a hospital has none of these. The District Nurses usually carry a supply. Good luck.

I never managed to find out because between leaving at 7 Saturday night and arriving back at 12 noon on Sunday, all the sachets had gone. We were there for 6 hours yesterday and they never applied anything despite us asking several times. I spoke to the consultant in the end because it’s causing Dad a lot of pain and he again said he would make sure something had been prescribed. I also asked the HCA if it had been put on Datix and she said she ‘thought so’. I’m hoping that mentioning that, like mentioning the skin integrity team, it will let them know that I know more than they think I do! It looked to have slightly healed around the outside and the HCA said it wasn’t weeping but it was wet enough to stick to the pad and leave a darker mark than before. I’ll try again today…

When my mum had a sore on her bottom, she told me that the hospital took regular photos of the sore, to see if it was getting better.

Your poor dad, he must be in agony.
The location suggests that is a moisture lesion caused by body fluids and/or sweat.
This is on them, their duty of care and their negligence.

As others have said, try all resources, or get them to, it’s their job and their colleagues on hand to help them! Suggest they contact the skin team etc or does it need you to contact Safeguarding, PALS, CQC and your MP for them to do their job in caring for his skin.
It is an absolute crying shame that a patient in hospital has got so much pain from such shoddy care and blatant neglect.

It beggars belief that a hospital is working in such silos when they are meant to be a team working for the health of the patient. My mother was in hospital and I took her appointment letter for the eye clinic at a neighbouring hospital in a few days time, they had seen it in the system and booked her into the eye clinic at that hospital to get checked, but that was pre covid.

My mother has a weak spot of skin and is prone to moisture lesion there, the district nurse comes out, takes a photo for the skin people, suggests pro shield cream but our GP gives derma pro which isn’t as good. They do twice weekly inspections and then weekly until it has healed and then use barrier cream to prevent it recurring which stops the sin being grazed off but creates moisture for the moisture lesion…there’s no win:win
Cavilon was mentioned by our district nurse and I said we would be guinnea pigs for it but nothing has come of that.
The nurse gave us a tube of pro shield and it usually helps but this time there’s not been any improvement. I tried Germolene cream - antiseptic and anaesthetic which probably isn’t strong enough and it has helped in the healing and shrinking of the wound, in the space of a week it has reduced by two thirds. There is a painful area around there because the nerves are affected by the tissue damage.

Some tell us to keep it moist and it will heal under the pro shield and others tell us to let it dry out and heal. Stand up and march on the spot at least every hour to let the blood flow round the area - yeah that’s ok but when she’s so sleepy…

I still can’t remember the name of the cream!

When I went Tuesday they’d had him up in the chair my some miracle but his BP had crashed and he was hooked up to various gadgets / fluids etc. I couldn’t get into the drawer so a nurse had a look but couldn’t find anything. When the HCA and a different nurse came in to help change him I said I wasn’t happy as there was now blood on the pad. They went to 3 other wards but no joy. Then they opened the drawer and found a box of the sachets sat there - no idea how the other nurse missed it!

Yesterday I said I wanted to have a look at the sore and a nurse immediately came over and said a new cream had been prescribed and they were hoping it was going to arrive yesterday evening. It’s called something-honey and is apparently very expensive so nobody likes to order it. It creates a sort of breathable dressing over the wound so that the pad has less chance of sticking to it - allegedly… we’ll see! I don’t care how much it costs them - if they had done something sooner it wouldn’t have got like this in the first place.

That’s probably Manuka Honey.

Was the cream Cavillon by any chance. I remember mum having this.

It had shield in the name I think but I might be able to grab a pic when I go in shortly. The honey one is something like Derma-honey or similar but probably has manuka honey in it. Honey in general has amazing antibacterial and soothing properties both externally and internally so I’m pleased that ‘we’ are seeing the benefits of more natural remedies again.

Derma Shield? Just checked, there is a product of this name.

Oh Henry’s Cat you shouldn’t have to be fighting like this, but it’s a good job you are.


They should be applying either Medihoney or Pro Shield - well, those are the 2 most common/well-known ones. Both are barrier creams.

If you ever see Sudocrem on it - this is not right! It’s a pain to wash off (because it’s like oil-based) and carers usually slap it on thick. :confused: And obviously, as you said, water-based emollients are no good either. It’s better off with nothing, in that regard.

I’m not sure if you can buy Medihoney or Pro Shield over the counter or without prescription ?

But I would escalate it further with a “higher up” and say you are concerned of it turning into more than a superficial wound. If it is leaving some blood on the pad then it is obviously already broken skin and not superficial though…

It’s terrible but threats of complaints/mentioning “CQC” would probably work, if you really need to get heavy handed and it sounds like you do…

I hope it works out!!!

Henry’scat, Proshield can be bought over the counter or online.

Proshield as you said isn’t the best if the skin is broken and there is blood, it might heal eventually over several weeks. I recently tried Germolene cream and it worked well for my mother although the nurse said it’s not something they would advocate but was very impressed at the recovery.

The hospital should be supplying the solution to the problem they caused.
Medi Derma Pro is cheaper and a poorer relation, it’s not as effective, even the district nurses have said so.

The initial cream they were using, which is the one that they kept saying they were out of, was indeed Medi-Derma S Total Barrier. The new prescription cream is Med-Honey. It is still as it was. There is broken skin (yellowy colour rather than blood) of about 1/2 inch wide and 1.5 inches long. The area around it by about 4-5 inches is red. Every time I go in I make a point of asking to see the sore even if I’m not one of the ones changing him. I don’t know how quickly it SHOULD heal with a good cream on it. If it was my baby I’d paint the area with egg white for when the nappy was on but leave them bare-bummed as much as possible. Obviously I can’t do either of those things with Dad! They do put a pillow under one side of him but it’s in the gluteal cleft (which I had to Google…) and he’s lost so much weight that there’s a lot of excess skin there. Personally I think he’d be better having a dressing on it and then using a convee to stop the area getting wet but there are so many issues that I’m struggling with which battles to choose!