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Medical Facilities are not Doing Enough to Prevent Pressure Ulcers on Patients’ Heels
By Nursing Home Law Center
Bed sores, or pressure ulcers, are serious yet preventable medical issues that affect many nursing home patients throughout the United States. Patients develop these ulcers due to unrelieved blood pressure in the lowest areas of the body, especially when a patient must remain stationary in bed or in a wheelchair for extended periods of time.
About 95% of pressure ulcers affect the lower half of the body, and the areas with the most bony protrusions are especially susceptible. The heels of the feet is one of the most common locations for pressure ulcers to manifest, and medical facilities appear to be failing in their duty to prevent pressure ulcers on patients' heels.
How do Pressure Ulcers Form on the Heels?
The calcaneus is the largest bone in the foot, but it has very little in terms of muscle coverage. This leaves it highly susceptible to developing pressure ulcers without appropriate preventive care. Pressure ulcers generally affect individuals over the age of 70, but even younger patients face a real risk of developing pressure ulcers in the heels.
The risk of sustaining bed sores increases for patients who suffer from certain medical conditions, such as malnourishment, diabetes, blood pressure complications, or recovering from hip fracture surgery. The heels are particularly vulnerable because blood can easily pool in the heels while lying in bed or sitting in a wheelchair for too long. Attending caregivers must be sure to regularly reposition sedentary patients to ensure bed sores do not develop.
The rate at which American nursing home patients are sustaining pressure ulcers in their heels could be due to poor preventive care, lack of awareness concerning the vulnerability of the heels to pressure ulcers, and unaddressed individual risk factors.
Complications From Pressure Ulcers on the Heels
The heels are especially vulnerable to pressure ulcers, due to the fact that most people put a great deal of pressure on their heels every day from standing and walking, any pressure ulcers in the heels can be extremely debilitating. A pressure ulcer is an open wound, therefore attending caregivers must routinely change a patient's bandages and keep the wound clean while it heals. Unfortunately, many factors could complicate the healing process, such as malnutrition, diabetes, or other medical issues such as obesity and motor disability.
Pressure ulcers start with discoloration of the skin; at first, the ulcer will appear reddened, then proceed to a blister-like appearance, followed by darkening of the skin as the affected tissues turn necrotic and die.
Careful monitoring is essential for preventing and treating bed sores; nursing home staff should reposition patients confined to bed rest or wheelchairs at a minimum of once every two hours. Higher-risk individuals may require more frequent repositioning. When a patient develops a bed sore, attending caregivers must monitor the wound at least once per week to track its growth and progression.
When a nursing home patient sustains a pressure ulcer on his or her heel, it can interfere with physical activity and increase the likelihood of falling injuries. In turn, these risks will lead to a greater risk of pressure ulcers during recovery. For example, a patient develops a pressure ulcer in his heel but caregivers do not notice it in time to prevent him from falling due to damage in the heel, suffering a hip fracture, and requiring extensive bed rest during recovery.
In this situation, the patient not only faces complications from the initial bed sore, but also possibly lengthy surgery that could cause more pressure ulcers to develop or existing ones to worsen. During recovery, he will require bed rest and more frequent repositioning than the average patient to prevent additional bed sore injuries.
Nursing Homes Need Proper Documentation and Prevention Policies
Bed sores qualify as a "Never Event," or a medical event that is provider-preventable and theoretically preventable in nearly every situation. When such injuries manifest, it is a clear indication of neglect, abuse, or failure to adopt strong prevention policies within health care facilities. Every state has unique laws concerning Never Events like bed sores and proper documentation and patient tracking regulations. When nursing homes fail to enact appropriate prevention and treatment policies, patients suffer the most.
Nursing homes can prevent pressure ulcers in patients' heels with proper preventive practices and keen observation. Patients who suffer from nutritional deficiencies and other medical complications face a higher risk of developing pressure ulcers and therefore require more personalized attention from caregivers.
When an attending physician notices a patient at significant risk of developing pressure ulcers in his or her heels, the physician will likely recommend an offloading medical brace to relieve pressure on the feet. When such a brace would cause pressure issues in other areas of the body, the physician will likely recommend pillows under the patient's calves during bed rest to offload the pressure on the heels. Ultimately, bed sores in the heels are completely preventable injuries with proper preventive care and documentation.