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Bed Sore Prevention
Did your loved one develop bedsores while residing in a nursing facility that could have been avoided had the nursing staff followed established protocols? Do you want to pursue justice and seek compensation for your damages?
At Nursing Home Law Center, our personal injury attorneys are legal advocates for all residents, assisted living facilities, and rehab centers. Call our legal team today at (800) 926-7565 (toll-free phone number) or use the contact form to schedule a free consultation.
Bedsores, also known as pressure ulcers, inflict pain on a person's skin and range from an annoyance to a condition that escalates and harms the body significantly. People can take multiple measures to enhance pressure sore prevention.
About one in ten patients who reside in nursing centers have bed sores which are very common when people stay in one place for too long without moving. Pressure sores form when pressure is applied to the skin for too long, restricting blood flow and nutrients, eventually killing it or leaving it at risk of infection.
A High Risk for Developing Pressure Wounds
Typically, people at higher risk of developing pressure ulcers include those who are:
- Elderly with poor circulation
- Mobility-challenged and always in bed or wheelchair
- Lacking hydration and nutrition,
- Experiencing disrupted blood flow such as diabetes
- Experiencing neurological disorders
Living with spinal cord injuries decreases one's sense of feeling, leading to the unawareness of pressure and bed sores. Being confined to a bed or wheelchair for extended time is challenging for patients with spinal injuries.
Bowel movement or bladder incontinence can also increase the risk of pressure ulcers.
The Most Common Form of Pressure Sores
The most common type of bedsore is called a "decubitus ulcer" that frequently develops on the tailbone, heels, shoulder blades, and hip areas.
People with paralysis or stroke can also develop "tissue crush injuries" when one remains in the same position for long periods without moving, especially on a bed, which cuts off circulation to various areas.
When bedsores happen, the affected skin area may appear red and moist. Pressure sores can also be gray, white, or yellow, depending on their severity, location on the body, and duration since they appeared.
People with hydration issues usually have dry skin, while inflamed skin is often an indicator of infection, likely caused by rupturing bedsores.
Pressure sores are typically classified on different scales according to their severity which includes:
- Stage I – In the initial stage of bed sore development, red or pink skin appears with slight swelling, bruising, or discomfort that may be present without any open areas of skin.
- Stage II – As the bed sore stage progresses, the skin is intact but becomes thin and dry, accompanied by tissue damage and discoloration. Open areas may appear in the skin and can be painful when touched,
- Stage III – The condition of the bed sore is crucial now that the skin is open with dark red or purplish hue due to blood loss. The bed sore is not usually accompanied by pain because of the dead tissue, but blistering may occur in various cases.
- Stage IV – The open bed sore wound or ulcer presents an increased risk of infection and may appear charred, blackened, or heavily damaged. The pressure wound is open, exposing muscle or bone, which requires extensive care.
- Unstageable – typically, an unstageable pressure wound involves an open pressure sore containing debris, necrotic tissue, or other organic material that blocks the doctor's view to identify the extent of the injury.
Managing Risk Factors
Before preventing bedsores, people must understand what causes the condition to manifest in the first place. The primary cause of pressure ulcers is extreme pressure on the skin, which restricts blood flow and nutrients. The three primary factors that result in bedsores include:
- Pressure: The applied pressure blocks the blood flow and other nutrients to the skin, resulting in the skin's and nearby tissues' weakness and death.
- Shear: When two contacting surfaces move in opposite directions, for example, when a patient is on a bed, shear occurs. Shear wears down the skin and leaves it vulnerable.
- Friction: A surface rubbing against another one leads to friction, for example, on a bed. As with shear, friction weakens the skin and leaves it susceptible to pressure ulcers and other conditions.
The risk factors for pressure sores generally involve the patient's lack of mobility or change of position, which increases pressure, shear, and friction on the skin.
Risk factors for pressure sores include:
- Age: Older adults are more prone to bed sores because their skin is thinner and less elastic than younger adults, so it cannot withstand the applied pressure.
- Poor Circulation: People who have circulation problems have an increased risk of developing bedsores because the blood
- Immobility: For example, a patient confined to a wheelchair or bed cannot move because of poor health, paralysis, spinal cord injury, or other conditions that limit movement could develop pressure sores.
- Lack of hydration and nutrition: A patient needs nutrients to keep the skin healthy and robust.
- Disrupted blood flow: Certain medical conditions such as diabetes affect blood flow, depriving the skin of nutrients and making it vulnerable.
- Lack of sensory perception: Neurological disorders, spinal cord injuries, and other related conditions result in loss of sensation in the patient's unawareness of skin pressure that develops bed sores.
The nursing staff keeps the patient's skin dry. It ensures that any bowel movement or incontinence is taken care of immediately when the resident is stationary in a bed or wheelchair.
Managing Bed Sores
Use pillows aligned to support the head, back, and buttocks when on a bed or wheelchair. Ensure your family member is positioned at a 90-degree angle or slightly higher when sleeping or lying down.
Ensure that they are also placed in an elevated position with pillows beneath the shoulders, hips, and knees when sitting upright in chairs, beds, or wheelchairs.
Maintain blood circulation in your loved one's legs by moving their feet around and massaging them regularly. In addition, ensure that they wear socks to keep their feet warm during winter.
Ensure that your family member is wearing clothes made of non-irritating materials.
Monitor the patient's feet for blood circulation every two hours to avoid the development of bedsores. If you see redness or discoloration, there is a high risk that bedsores may develop if left untreated.
If your family member has diabetes, they should be regularly checked for foot injuries and infections to prevent pressure sores from developing.
When your loved one is in the shower, ensure they remain seated and do not attempt standing up unless they can do so safely.
Alzheimer's, Dementia, and Developing a Pressure Ulcer
If your family member has Alzheimer's disease or another type of dementia that makes him more likely to try and stand on their own, install a safety bar in the shower or a barrier on the bed.
Contact your loved one's physician in case of an injury or open wound to prevent bedsores from developing. Ensure that the physician measures the affected area and indicates that this is a potential risk for bedsores to occur.
If you observe your affected family members trying to get out of beds or wheelchairs, assist them quickly to avoid developing bedsores.
Many Mobility-Challenge Patients Need Help
If your loved one is at risk for pressure sores, ensure that the nursing staff updates their medical records content and indicates that this may happen if they do not follow specific protocols. This way, the nursing team will know what to do if the nursing resident develops bedsores while under their care.
Implementing these steps can prevent pressure sores in your loved ones while they reside in a nursing center. Pressure sore lawyers at Nursing Home Law Center at (800) 926-7565 could assist you if your family member developed bed sores that could have been prevented by following proper medical care protocols like having an appropriate wheelchair.
Our law firm can take legal steps to stop the abuse and neglect immediately and forcefully ensure the nursing resident receives the best care, is relocated to another facility, or is hospitalized to safeguard their health and well-being.
Prevention of Bedsores
The primary method for preventing the development of pressure sores is changing positions and using specialized beds. However, this method is not an option for every patient, particularly those who lack mobility. Instead, caregivers can prevent pressure ulcers through measures such as:
- Repositioning –People can prevent most cases of bedsores if they move from time to time. Occasional motion stops pressure from building up on skin surfaces and affecting blood flow. Doctors, nurses, and care professionals should move immobile seniors every two hours.
- Supportive surfaces –Using supporting surfaces such as additional padding and mattresses reduces the pressure applied to the skin. These dynamic surfaces either alter the air pressure below the surface or use silicone-coated beads that liquefy by having air pumped through. These surfaces are ideal for individuals who cannot move.
- Nutrition –A healthy intake of water and nutrients enriches the skin and other tissues in the body. Reinforced, healthy skin is less vulnerable to pressure and other factors that could weaken it.
- Skin Care – The nursing staff keeps the resident's skin clean, hydrated, and well-nourished. Washing the skin with soap and water removes dead cells that increase vulnerability to pressure ulcers.
- Assist with toileting – Be proactive in changing the patient's position to avoid pressure on any part of the body long enough to cause pressure ulcers.
- Limit movement while sleeping
The primary method for preventing bedsores is changing positions frequently. However, this method is not an option for every patient, particularly those who lack mobility in their lower limbs and cannot change positions independently.
The Importance of Skincare
Skincare is of the utmost importance and ensures that an aging patient does not develop a pressure wound while staying at a nursing center or assisted living facility.
Proper skincare habits maintain the skin and prevent risk factors for pressure ulcers. Best practices of skin care include:
- Inspecting the skin daily for any signs of bedsores
- Protecting the skin from sores through the application of talcum powder and lotion to vulnerable areas
- Cleaning and drying the skin regularly to prevent dangerous agents such as urine, moisture, and stool from sitting on the skin resulting in sores
Other Preventive Measures
Minor management steps people can take to prevent the formation of bedsores include:
- Checking on early-stage bedsores manifest as red spots on the skin that stay red when pinched
- Monitoring pressure ulcer "hot spots," such as the buttocks and the heels
- Taking preventive measures even without a diagnosed pressure sore
- Follow protocols to prevent malnutrition and dehydration or other serious complication that can lead to sores
Pressure ulcers bring notable amounts of suffering to individuals and can escalate to deadly infections. However, by taking simple measures that prevent vulnerable skin, people can avoid developing pressure sore and the problems they bring.
How Do Hospitals Prevent Pressure Ulcers, and Why Don't Nursing Homes Use the Same Protocols?
Data reveals that hospitals have significantly fewer pressure ulcer events among elderly, immobile, and disabled people than nursing home residents. Statistically, hospitals have a rate of 5 percent, while nursing facilities have a 38 percent occurrence.
What are the differences between hospitals and nursing centers that cause this difference? The answer lies in the protocol for preventing pressure ulcers.
Hospitals take precautions to guard against bedsores among their patients by frequently rotating their positions or changing them on special air mattresses in specialized beds to prevent bedsores. The following are simple steps for a hospital to prevent bedsores from occurring:
- Initiate hourly turning of patients who have mobility issues.
- Inspect patients daily for signs of pressure ulcers or other factors that cause their formation, such as infections or blood sugar irregularities.
Hospitals ensure that the patient has accurate health information in the plan of care that the nursing staff strictly follows to reduce problems with their diet, mobility issues, and overall quality of life, which can lead to sores.
On the other hand, nursing homes and assisted living facilities to do little to ensure that their patients get enough movement or attention from staff members who can monitor them regularly for any signs of a pressure ulcer. In addition, residents in nursing centers get less frequent opportunities to move around than hospital patients.
Many nursing homes fail to implement the same established protocols in their residents' care. The American Health Care Association recommends that nursing facilities use the same protocols as hospitals when caring for immobile and vulnerable residents to ensure they do not develop bedsores.
Warning Signs of Skin Breakdown in Elderly Loved Ones
A patient's skin is often the first indicator that something is wrong. Knowing what to look for during a regularly scheduled visit can help protect your family member from further injury.
There are several warning signs of breakdown in elderly nursing home residents. In many cases, detecting these signs is difficult because they may not manifest suddenly and require immediate action. Concerns may include:
- Skin color changes. It can become pale, blotchy, or dark because of blood clotting under the skin's surface. Check the feet' soles for dark discolorations typically caused by blood pooling there because of poor circulation. Even slight changes to normal pigment can indicate a more significant problem.
- Bruising and swelling can be caused by injury or other underlying conditions, such as blood clots. The area around the bruise will feel firm and warm to the skin. Blood supply may also be slower in that part of the body due to decreased circulation, causing skin tissue above the clot to die.
- Small, red dots on the body are caused by broken capillaries from poor circulation or aging. These "spider veins" do not burst and require no treatment, but a doctor or other healthcare provider should check them to ensure that nothing more serious is causing them.
Common Sites of Bed Sores and How to Prevent Them from Happening or Recurring
A pressure sore commonly develops at the following sites:
- The skin over any bony prominence that presses into a mattress, such as ankles and heels. If you notice reddened or bruised skin with no history of injury, it may indicate a body area of pressure sore development.
- The tailbone, especially if the patient has to sit for an extended time
- The skin under an immobile patient's back. This body area can be difficult to monitor because the patient cannot feel any pain in this area and it is not easily seen when they are lying down. Unfortunately, this is a common site for bedsores among nursing home residents with paralysis or other temporary or permanent loss of sensation.
- The skin over the shoulder blades, especially if the patient has to remain stationary for extended periods, restricts blood supply. These are common body areas for pressure sores among patients with paraplegia or quadriplegia.
According to the Pressure Ulcer Advisory Panel and the American College of Physicians, skin irritation and the lack of barrier creams contribute to degrading skin integrity and other health conditions.
The presence of skin tears, erythema, or open wounds that are stages 1–3 of the Braden Scale can help diagnose weakened skin integrity.
Skin tears are usually defined as recent breaks in the continuity of the epidermis resulting in blood leakage under the dressing. In contrast, Stage I is characterized by non-blanchable erythema in pressure areas with or without tissue damage.
Surgical Debridement and Other Treatments for Bedsores
In advanced stages, pressure injuries (decubitus ulcers) are typically diagnosed due to the necrotic tissue where the wound has blackened, exposing muscle, bone, and tendons below.
Typically, at this stage, the surgeon will perform debridement for the surgically removed dead tissue, creating a healthier environment more conducive to healing.
Cutting Away Dead Tissue
However, debriding (surgically removing) dead tissue on the elderly does not always produce the desired outcome due to their age, comorbidities, or other health problems with their health that could minimize the healing process.
Typically, Stage IV (life-threatening) bedsores should be treated only by an advanced medical team specializing in pressure sore care. These doctors and nurses have dedicated their entire careers to understanding the science of wound care and how best to treat those wounds.
In the event of non-life-threatening bedsores, as is most often the situation with elderly nursing home residents, a podiatrist, specialized caregiver, or another medical professional familiar with pressure sore care can provide treatment.
Using Barrier Cream Products
However, in severe cases involving untreated Stage II or Stage III ulcers, the health care provider might use sterile products, including barrier creams, for regular dressing changes and other treatments to avoid infection.
Ask their doctor for tips on how often these vital dressings content changed for patients who are not unconscious and can understand verbal instructions. This frequency will depend on the wound's stage and whether any drainage is involved.
Contact a doctor immediately if you notice a strong odor, skin breakdown, redness spreading from the wound, or increased swelling.
Change Dressing Often
For nursing home residents who cannot understand verbal instructions, change their dressings content at least once daily to remove any drainage and keep the skin clean and dry. Consult a doctor if you notice a strong odor, redness spreading from the wound, or increased swelling.
In addition to barrier cream products, topical treatments can be applied to the skin surrounding pressure wounds to minimize pain and promote faster healing. These include silver-based or zinc-based wound dressings designed to reduce odor, promote shorter healing times, and prevent infection in wounds with necrotic tissue.
Hiring a Nursing Home Neglect Attorney to Resolve Your Compensation Case
Were you or a loved one diagnosed with preventable severe pressure sores caused by the nursing staff not following pressure wound care protocols? Did you lose a loved one through a preventable death after suffering a horrific life-threatening decubitus ulcer?
At Nursing Home Law Center, our elderly abuse attorneys can help you pursue justice and seek the financial compensation your family deserves. Call our law office at (800) 926-7565 (toll-free phone number) or use the contact form today to schedule a free case evaluation.
All confidential or sensitive information you share with our pressure sore injury legal team remains private through an attorney-client relationship.