Federal Guidelines Suggest Specific Measures for Preventing and Treating Bed Sores

By Nursing Home Law Center

Guidelines

A recent article in the Journal of the American Medical Directors Association takes a look at federal bed sore laws enacted in 2004, and how they can help patients today. Using the laws as guideposts, the article explains in detail what hospitals and nursing homes can do to treat and prevent bed sores, or decubitus ulcers.

Prevention

First, the guidelines emphasize that proper nutrition is essential to preventing bed sores, particularly a patient’s protein intake. Patients without enough protein in their diet aren’t usually able to heal wounds effectively.

“Nutritional goals for a resident… who has a pressure ulcer, or is at risk of developing pressure ulcers, should include a protein intake of approximately 1.2-1.5 grams per kilogram of body weight”, the study says. The USDA also recommends that elderly people consume approximately 50-60 grams of protein per day.

Along with protein intake, the guidelines urge doctors to pay special attention to issues of fecal incontinence, which can be ultimately more damaging than urinary incontinence.

“Some studies have found that fecal incontinence may pose a greater threat to skin integrity”, the guidelines state.

Treatment: Patient Rights

In terms of actually treating bed sores, the laws give strict measures about patients’ fundamental rights. The laws remind doctors that even the most vulnerable patients deserve proper care.

“The fact that a patient is a ‘do-not-resuscitate,’ or on hospice, cannot be used as a reason to withhold pressure ulcer care, or to explain a worsening pressure ulcer”, the laws state. “A do-not-resuscitate order alone does not mean that ulcer care can be discontinued or limited”.

The laws also state that patients have the right to refuse bed sore treatment, but that that the refusal must be documented.

Treatment: Assessment

In order for bed sores to heal properly, they must first be accurately assessed. The bed sore laws give doctors specific protocol for making an initial identification:

  • Differentiate the type of ulcer (pressure-related vs. non-pressure related)
  • Determine the ulcer’s “stage” (1-4 on the Braden Scale)
  • Describe and monitor the ulcer’s characteristics
  • Assess, treat and monitor pain

On a weekly basis, the laws say doctors should:

  • Examine the size, depth and location of the bed sore; noting if any colors or odors have changed.
  • Monitor and manage the patient’s pain level
  • Accurately describe the tissue at the edge of the wound

The AMDA article reminds readers that pressure ulcers typically don’t "reverse stage", or go from a high-stage ulcer (Stage 3 or 4), to a lower 1 or 2 stage.

“Wounds do not progress toward healing in a manner that is consistent with down staging”, the article says. “Rather, wounds heal by contraction and scar formation”.

The article notes that pressure ulcers should begin healing within two to four weeks of starting treatment.

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