Who’s to Blame for Bed Sores in the Obese? Or are They an Inevitable Part of Being Fat?

ScaleIf you or a loved one is overweight, it could increase the risk of developing bed sores during a stay at a hospital or nursing home. Obesity can contribute to both immobility and pressure on the surfaces of the skin – two main causes of bed sores. Yet an increased risk does not mean bed sores are inevitable in overweight patients. Pressure sores are still preventable with proper patient care. It is a nurse’s responsibility to identify high-risk pressure ulcer patients and provide more effective prevention.

Body Mass Index and Bed Sores

Studies have proven the relationship between obesity and bed sores. Body mass index (BMI) can be a positive predictor of pressure ulcers in hospital patients. Patients with extreme obesity are around twice as likely to develop ulcers as patients at average weights. When obese patients enter intensive care units, they may suffer immobility that results in prolonged pressure on certain parts of the body. Without relieving this pressure at regular intervals, pressure ulcers can occur.

A greater body weight means more pressure on vulnerable patches of skin during bed rest, such as on the buttocks or shoulder blades, than the average patient. It also means greater difficulty for nurses and assistants whose job it is to turn the patient to prevent bed sores. A greater BMI makes the process of turning more labor-intensive for staff members. This can unfortunately result in nurses failing at properly turning the patient, and prolonged pressure on vulnerable areas.

Obesity may also increase the risk of bed sores and infections because of skin challenges. Obesity can affect wound development and healing through related complications such as incontinence, dermatitis, and fungal infections. Once a bed sore compromises the integrity of the skin, these obesity-connected factors can cause infections and inhibit wound healing. For this reason, obese patients are not only at greater risk of bed sores, but also of bed sore morbidity. It is crucial for a nursing staff to recognize these risks and act to prevent them.

Liability for Failure to Prevent Bed Sores

Bed sores are not an inevitable part of a patient being overweight. They are preventable in obese patients just as much as they are in an average-sized individual. They are, however, more common. This imposes a greater duty of care on nursing staff members for the prevention of bed sores. Everyone involved in an obese patient’s care should be aware of the risk of pressure ulcers, and should be on the same page when it comes to preventing them. Steps necessary to prevent bed sores in overweight patients may include:

  • Frequent turning. Most immobile hospital patients require turning every two hours to prevent pressure buildup. However, a physician may recommend more frequent turning for an obese patient.
  • A turning schedule. Keeping track of when and where someone last turned a patient is important in bed sore prevention. Otherwise, nursing staff may forget or miss a patient’s turning requirement.
  • Proactive prevention plan. A high-risk bed sore patient may require a more proactive approach to prevention. Devices and products exist to help prevent bed sores, such as special sheets, cushions, and moving beds.

It is possible to prevent bed sores in an obese patient. Prevention may simply require greater effort and care on the hospital staff’s part. If an obese patient or nursing home resident develops serious bed sores, or a major infection because of a bed sore, the facility could be liable for damages. Liability may fall to a hospital if it fails to fulfill accepted standards of patient care. If a reasonable and prudent nursing staff could have prevented the bed sores, the facility may have to pay for the patient’s medical bills, pain and suffering, and other losses.


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