Sick hospital patients and elderly nursing home residents are at risk for developing pressure wounds when the staff fails to follow established skin care protocols.
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US Bed Sore StatisticsAccording to the Centers for Disease Control and Prevention's National Center for Health Statistics, noninstitutionalized adults aged 65 and older in the United States (US) increased from 15 million in 1999 to 19 million in 2011.
In addition, approximately 46% of people over 65 years old are predicted to have at least one pressure ulcer during their lifetime.
According to the "Journal of Gerontology," between 65% - 80% of older adults require assistance with one or more self-care activities, which may include getting in and out of bed or chairs, eating, toileting, bathing, and dressing.
The Journal also reports many different health risks associated with pressure wounds, including infection and sepsis. These can be extremely dangerous to the patient's health if left untreated or not handled correctly.
Pressure ulcer prevalence typically occurs on the arm, wrist, back of the knee, ankle, hip/buttock, or heel. However, all body areas that remain under pressure can cause a pressure wound or ulcer to form.
A commonly reported complication is infection. In addition, sepsis, which is blood poisoning, can occur when bacteria enter the body through open cuts or sores.
Restricted Movement Leads to Pressure UlcersPressure wounds often develop when a lack of movement and time in bed leads to skin breakdowns that result in wounds. These wounds are painful and can lead to infections.
To avoid this, it is important for those who suffer from injuries to take the necessary precautions with their health care providers and themselves. In addition, it is crucial to get elderly patients moving and up to reduce the risk of pressure wounds.
In a research article, "Nationwide Inpatient Sample: 2006 - 2009," from Advances in Skin & Wound Care, the incidence rate of pressure wounds is found during five years at a nursing facility. The study reported 52 million hospital admissions, where 2.1 percent of patients developed pressure sores.
More than half of these cases were related to the development of pressure wounds after surgery or injury to the tissue where healing may be hindered.
According to the article "Risk Factors for Development and Progression of Bed Sores," many factors can increase the risk of pressure sores. Patient factors that increase the risk of pressure wounds or ulcers include:
Physical aspects of health care can also increase the risk of pressure wounds. These include:
Some other factors that increase the risk of decubitus ulcers or sores include:
Certain conditions can affect patients, such as:
It is essential to take the necessary precautions with pressure sores and pressure wounds including, discussing risks and treatments with a healthcare provider. In addition, those who suffer from decubitus ulcers should be moved regularly and kept comfortable as much as possible.
One report revealed many different tools to assess whether an individual is at risk of developing pressure wounds. For example, diagnosticians and doctors use the Braden Scale as a risk assessment tool.
The Braden Scale can be used to assess the risk of pressure sores, including:
Some other factors that can be considered in some pressure sore cases include:
The more risk factors a person has, the higher the likelihood is of getting pressure wounds, ulcers, or sores. This scale also shows the importance of talking to a doctor about pressure wounds, ulcers, and sores.
In a research article, "Gender Influence on Pressure Wound Severity in Acute Care Surgical Patients," it is reported that there are many different factors related to gender and pressure wounds.
Male patients were found to have more severe pressure sore severity based on specific contributing factors. These included:
In addition, female patients had worse pressure wounds that were more likely to become infected.
One study reported that "pressure wounds" are often used in the United States to describe a type of skin lesion or damage caused by pressure. Pressure sores can occur when a patient's surface has been constantly pressed against, such as from being bedridden.
Pressure on a bony area could reduce oxygenated blood flow to the body's tissues, damaging or killing cells, leading to a pressure sore.
Some examples of signs of pressure wounds, ulcers, or pressure sores include:
There are also various types of pressure wounds that are more specific to certain parts of the body. For instance, a "heel" pressure wound is located on the bottom of the foot and a "decubitus ulcer" is typically on bony points such as elbows and heels.
In addition, it is also important to keep in mind that some pressure wounds or ulcers may be more severe than others. These include:
A common cause of pressure wounds is "bed rest" and occurs when patients must remain in one place for an extended period. They may be bedridden at home or in a hospital bed. Other factors that can contribute to pressure wounds include:
A research article, "Pressure Ulcers," reported that pressure sores are non-healing lesions of the skin and tissues underneath the skin and can be caused by external forces or friction on the skin.
Bedsores Are Both Common and CostlyAccording to the US Department of Health and Human Services, bedsores are one of the most common injuries in healthcare settings. They are also among the costliest, with an estimated annual price tag of $11 billion nationally.
Data reveals that the cost to treat one pressure sore in a caregiving facility can be upwards of $25,000. In addition, as a 'never event,' developing a facility-acquired pressure sore indicates that the staff failed to follow established pressure ulcer prevention protocols.
Some studies have evaluated the cost-effectiveness of the nursing staff and hospital medical team following pressure ulcer prevention protocols when treating nursing home patients.
Pressure Sores and Nursing HomesNursing homes are one of the most common settings for pressure sores. The US Department of Health and Human Services reports that 98,000 to 99,000 elder home residents develop at least one pressure ulcer every year.
This number accounts for about 37 percent of those living in long-term care facilities. In addition, in some cases, elderly patients admitted to nursing facilities from acute care hospitals arrived with at least one pressure sore at some stage of wound healing.
Patient outcomes can maximize the resident's prognosis after receiving immediate treatment and using specialized devices, including air-fluidized beds, occlusive dressings, and support surfaces.
Conversely, hospitalized patients admitted with at least one stage IV pressure sore could be at a life-threatening stage if the wound led to osteomyelitis (bone infection) or sepsis (blood infection).
Facts About Pressure UlcersAccording to the San Francisco Gate, experts estimate that as many as 80 percent of those living in nursing homes and acute care hospitals will develop at least one pressure ulcer during their lifetime. This number increases to 95 percent for those on ventilators or who use feeding tubes.
A more recent study estimated between 24 and 71 percent of total elder home residents develop pressure ulcers annually.
The Prevalence of Pressure SoresAccording to the Journal of Clinical Nursing, more than 15 percent of patients over the age of 50 will develop an unstageable pressure ulcer at some point in their life. In addition, of those with bedsores, one-third will die as a direct result of the pressure ulcer.
The Mortality Rate for Pressure Injuries (Pressure Ulcers)While not everyone who develops bedsore will die due to it, mortality rates are high for those with pressure injuries. Some studies show that the likelihood of pressure sores resulting in death for hospital patients is 3.3 percent.
In comparison, the chance of dying after developing pressure sores or pressure wounds that have advanced to osteomyelitis is 5.1 percent.
Pressure Ulcer PreventionWhile there are no guarantees that any senior home resident will avoid pressure sores if they live long enough, steps can be taken to reduce the risk significantly. According to WebMD, these include:
One report indicates that one in four people who develop pressure sores will die due to their unhealed pressure ulcer. Of those who survive, many will develop complications that require additional surgeries and ongoing care.
Pressure sores are very dangerous because they can lead to sepsis, a condition in which bacteria enter the body and cause an inflammatory immune response that can result in organ failure or death.
How Does the Doctor Know There's a Pressure Sore?If someone notices that a person they are taking care of has developed an unusual sore that is not healing, they should contact their doctor. For example, a pressure sore can indicate something wrong with the patient's health or treatment plan.
It is important to seek medical assistance as soon as possible so the patient's health does not deteriorate. Performing a pressure ulcer risk assessment or asking specific questions and performing a physical exam to determine if the patient has pressure sores is integral to long-term care.
Skin Breakdown, Managing Pressure Ulcers, and the Surgical Care UnitAccording to the Wound Care Network, pressure sores are classified into four stages. These include:
According to the Wound Care Network, surgical wounds are especially susceptible to pressure ulcers because they are open sores exposed to trauma during surgeries that require incisions or removal of body tissue.
These wounds can become infected with staph, strep, or other types of bacteria that can cause the wound to become further inflamed and require antibiotics or possibly surgery in a surgical intensive care unit.
Pressure Ulcers Can Be FatalAccording to the National Pressure Ulcer Advisory Panel website, about 243,000 people die annually due to pressure ulcers. In addition, the Journal of Nursing Scholarship found that one in four people who develop pressure ulcers will die as a direct result of having had a pressure wound.
In addition to physical discomfort and pain, pressure ulcers can cause serious complications. When skin is injured, it becomes more difficult for the body to fight infection so that an open wound can become septic very quickly.
Life-threatening sepsis occurs when bacteria enter the body through the wound and causes an inflammatory response that leads to organ failure or death.
Surviving family members who lost a loved one through fatal bedsores can file a wrongful death lawsuit seeking compensation and justice from negligent caregivers. In addition to funeral and burial costs, the wrongful death lawsuit should provide enough funds to pay for hospitalization bills, lost wages, loss of companionship/consortium, loss of future earnings, pain, grief, and suffering.
Pressure Ulcers Can Cause Other Medical ComplicationsAccording to the Wound Care Network, some medical conditions and treatments can make it more difficult for wounds to heal. These include:
According to the National Pressure Ulcer Advisory Panel website, pressure sores can be successfully treated and prevented with early detection and appropriate treatment.
However, a pressure sore may heal on its own after at least two weeks of treatment, or it may require debridement and eschar removal by a healthcare professional.
The removal of dead tissue, also known as debridement, is an important stage in pressure sore treatment that can help prevent pressure sores from spreading and causing more problems.
According to the National Pressure Ulcer Advisory Panel website, early detection of pressure sores is important for preventing further tissue damage caused by the continued development of chronic wounds. In a randomized controlled trial study, pressure ulcers were prevented and healed faster in patients who used pressure relief devices and received debridement treatment.
A lack of blood flow causes bedsores. The sore could progress inward towards the bone as they worsen. Without early detection and treatment, an infection can enter the bloodstream and spread throughout the body.
Treating pressure ulcers to optimize the healing of granulation tissue often requires the use of medical devices. Transporting the resident across support surfaces and allowing them to rest on air-fluidized beds helps eliminate sheer friction forces and offloading pressure on the back of the head, shoulders, sacrum, and heels.
Litigation Relating to Developing Preventable Pressure UlcersIn a case study from 2014, a woman died from pressure ulcers caused by her hospital's failure to prevent pressure sores. In this case, the patient had been bedridden due to two hip surgeries and was at risk for developing bedsores.
She was admitted to a rehabilitation facility after being discharged from the hospital because she was at an increased risk of getting pressure sores if she was not turned frequently. The facility discharged her to the hospital for IV antibiotic treatment, with strict orders to monitor and treat any developing pressure ulcers.
When the patient was readmitted to the rehabilitation facility, she had two pressure ulcers on her sacrum and hips. As a result, she experienced cardiac arrest and septic shock due to the pressure sores aggressively invading her bloodstream. Unfortunately, she died two weeks after the cardiac arrest occurred.
The family sued for medical malpractice, among other things, since it was proven that she would not have developed pressure ulcers if she had received appropriate treatment at the facility.
The Aftermath of the DeathThe hospital that treated her agreed to settle for $15 million; the rehabilitation facility agreed to pay $4.1 million. The patient's family appealed for more compensation since it was proven that she would not have died if proper treatment had been administered when she returned to the facility after being discharged from the hospital.
The case was settled for $19.1 million.
Senior Home Residents Typically Underestimate the Medical Dangers of Developing Pressure SoresIn a case study from 2009, a nursing home resident developed bedsores due to being confined in bed after multiple hip surgeries.
When she was admitted into the facility, her mobility was limited, and a doctor ordered complete bed rest. However, it seemed like no one read or understood this order because they failed to follow pressure ulcers protocol.
The resident's family sued for medical malpractice, believing that the facility had a responsibility to provide their loved one with treatment and assistance if she could not care for herself.
Instead, the staff failed to effectively manage her skincare, allowing a pressure sore to develop, without implementing established pressure ulcer healing methods.
Their argument proved valid, as the facility agreed to pay an undisclosed amount of money in a settlement with the family.
Did you or a loved one develop a Pressure ulcer while residing in a nursing facility caused by the negligent actions of caregivers?
The affiliated bedsore injury attorneys at Nursing Home Law Center are legal advocates for senior home residents and elderly patients victimized by medical malpractice and negligence.
Call our law office at (800) 926-7565 (toll-free phone number) or use the contact form today to schedule a free case evaluation. Our legal team accepts all personal injury cases and wrongful death lawsuits through contingency fee agreements, meaning no upfront fees are required until your case is resolved through a negotiated settlement or jury award.
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