Avoidable Harm or Unpreventable Outcome? How Tissue Viability Nurse Expert Witnesses Clarify Pressure Ulcer Disputes
- Apex Experts
- Sep 30, 2025
- 4 min read
Pressure ulcers, also known as pressure sores, pressure injuries, or bedsores, remain one of the most frequently litigated harms in nursing care. These injuries can develop quickly, cause severe pain and infection, and in extreme cases, contribute to death. From a legal perspective, determining whether a pressure ulcer was avoidable, recognised early, and appropriately managed is critical in assessing breach and causation.
Solicitors handling clinical negligence or inquest cases often require the opinion of a tissue viability nurse expert witness. These specialists offer detailed insight into wound prevention, assessment, and escalation protocols, helping legal teams evaluate the quality of nursing care provided.
What Is a Tissue Viability Nurse Expert Witness?
A tissue viability nurse expert witness is a senior registered nurse, often an advanced clinical practitioner or clinical nurse specialist, with extensive experience in the prevention and management of complex wounds. Typically, these professionals work in tissue viability services within hospitals, community settings, or integrated care systems.
They are responsible for:
Advising on wound care plans
Implementing pressure area care protocols
Training frontline staff in risk reduction
Auditing pressure ulcer incidents for root cause analysis
In a medico-legal context, their role expands to include:
Reviewing clinical records and care documentation
Assessing whether recognised standards were met
Applying national guidelines such as NICE frameworks
Offering CPR 35-compliant opinions on breach of duty, liability, and causation
Why Are Pressure Ulcer Claims So Prevalent?
Pressure ulcers are widely viewed as a ‘never event’ in many healthcare environments, meaning that with the right preventative care, they should not occur. As a result, they are a common basis for clinical negligence claims, especially when the ulcer progresses to a Grade 3 or 4 injury.
Solicitors may pursue cases involving:
Hospital-acquired pressure ulcers, especially where patients were immobile post-surgery or lacked appropriate repositioning
Care home and domiciliary neglect, including failure to identify risk in frail, elderly, or bed-bound individuals
Inadequate documentation or escalation, where early signs of skin damage were ignored or poorly recorded
Omission of pressure-relieving equipment, such as dynamic mattresses, cushions, or offloading boots
Delayed referral to a tissue viability nurse, resulting in missed opportunities for early intervention
Pressure ulcer claims often involve bundles of nursing notes, care plans, risk assessments (e.g. Waterlow scores), and multidisciplinary records. A Tissue Viability Nurse Expert Witness brings clarity and clinical authority to this complex documentation.
Legal Context: Bolam, Bolitho, and Best Practice Standards
As with other clinical negligence claims, pressure ulcer cases are assessed using the Bolam and Bolitho tests:
Bolam: fid the actions taken align with those that a responsible body of nursing professionals would have undertaken?
Bolitho: eas the care provided logical, evidence-based, and defensible?
In addition to these legal standards, TVN experts consider:
The goal is to establish whether the pressure injury was truly unavoidable or if substandard nursing contributed to its development or progression.
What Does a Tissue Viability Expert Report Include?
Every Apex report is carefully structured to meet legal standards and provide objective clinical insight. A typical TVN report includes:
Expert credentials and impartiality declaration
Full chronology of the pressure injury, from risk identification to wound management
Review of nursing and therapy documentation, including skin assessments, turning charts, mattress provision, and escalation records
Comparison to best practice standards using NICE, NMC, and professional body guidance
Opinions on breach of duty, causation and liability
All reports are written in plain English and internally peer-reviewed to ensure clarity, neutrality, and CPR 35 compliance.
Beyond Litigation: Inquests, SIIs, and Safeguarding Reviews
Tissue viability experts are also invaluable outside of formal litigation. Apex TVNs are regularly instructed in:
Coroner’s inquests: Where pressure ulcers are cited as contributing to death
Serious incident investigations (SIIs): Especially where policy breaches or systemic failings are suspected
Safeguarding reviews: When poor skin care in care homes or community settings leads to neglect allegations
In these contexts, a clear, timely nursing opinion can support internal investigations, shape public narratives, and drive service improvement.
Why Choose Apex for Tissue Viability Nursing Opinions?
Apex Experts has built a trusted panel of senior nurses with specific qualifications and experience in tissue viability, wound care, and complex case management. Our service offers:
Advanced practice experts with postgraduate wound care training and leadership roles
Structured, CPR 35-compliant reports, reviewed for tone, neutrality, and evidence-based rationale
Fast turnaround times, including urgent instructions and rapid-response options
Full administrative support for collating records, managing deadlines, and assisting with expert conferences
Our reports are relied upon by leading clinical negligence firms, local authorities, and NHS legal teams across the UK.
Report Turnaround and Flexibility
Apex understands the need for speed and flexibility. We offer:
Full CPR compliant breach of duty and causation reports: 6-8 weeks
Screening reports: 6-8 weeks
Short, pre-litigation letters of advice: 2-4 weeks
Deferred payment terms: available where needed
We also support supplementary opinions, joint reports, and court testimony where required.
Need to instruct a Tissue Viability Nurse Expert Witness?
Pressure ulcer claims require both legal precision and clinical depth. A tissue viability nurse expert witness provides essential clarity, helping determine whether a wound was the result of neglect, poor documentation, or truly unavoidable circumstances. These experts interpret complex nursing records and align findings with national standards, giving solicitors the insight needed to argue breach, causation, and quantum effectively.
At Apex Experts, we ensure that each TVN instruction delivers a high-quality, timely, and court-ready report, supported by a team that understands the sensitivity and urgency of pressure ulcer claims.
Get in contact with us at info@apexexperts.co.uk, give us a call on 0203 633 2213 or visit our contact us page.