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Why do Facilities Need to “Off Load” Patients?
By Nursing Home Law Center
To off load a patient is to remove the pressure from an area for at least one minute. The purpose is to prevent the development of bedsores, or pressure sores, which result from continued pressure to an area resulting in restricted blood flow. This lack of blood flow jeopardizes the viability of skin and underlying tissue.
What is a Bedsore?
Bedsores, also called decubitus ulcers and pressure sores, form due to continuous pressure on skin and underlying tissues, which restricts blood flow. This restricted blood flow causes the skin to die and the ulcer to develop. This is not normally an issue as people move around and shift their weight. When a patient in a hospital bed or a nursing home patient remains immobilized for long periods, however, they risk pressure sores from damage to the skin.
A bedsore, when it develops, will progress through four different stages of severity, the last of which is considered life threatening.
- Stage I. In the initial stage the skin is still intact but has turned red. The skin may feel hard and warm to the touch. In addition, the affected area may be swollen.
- Stage II. In the second stage the skin's integrity has been compromised. A small abrasion may result, or perhaps a blister.
- Stage III. In stage three the skin has completely worn down, revealing tissue underneath. The underlying tissue may be damaged. Swift treatment is crucial.
- Stage IV. In the final, most severe stage, the tissue underneath the skin has been breached. The muscle or even the bone underneath is damaged and can be seen with the naked eye. The danger from infection and sepsis is now severe.
Why do Bedsores Develop?
Bedsores develop because continuous pressure to an area restricts the flow of blood. Over time, the skin weakens and dies, as does the tissue underneath. An area of the skin might experience continuous pressure that compromises its health and viability for various reasons.
- Paralysis. Without the ability to move one's limbs, one cannot relieve pressure on his or her body and bedsores will eventually develop.
- Diabetes. Diabetes can reduce feeling in one's limbs, which hampers one's ability to detect a developing problem. Diabetics' wounds also heal more slowly. For this reason, doctors instruct them to look over their feet daily for signs of developing wounds.
- Coma. Unconscious patients are at heightened risk for developing bedsores.
- Weakness. Some patients are very sick and lack the energy to shift their bodies to relieve pressure. Elderly patients often suffer from the same lack of strength to move.
While ultimately it is the lack of blood flow due to continuous pressure that causes bedsores, other factors can aggravate the problem.
- Smoking. The bodies of smokers are compromised in their ability to heal. Once a bedsore begins to develop in a smoker, the problem is harder to treat, and can progress more rapidly.
- Atheroma. Plaque buildup in the arteries is another way of restricting blood flow, making the sufferer more vulnerable to bedsores when pressure is continuously applied to an area of the body.
- Dehydration. Dehydrated skin is less healthy skin, and therefore more prone to developing bedsores. Good nutrition and lots of water are especially important for patients who are confined to a bed or wheelchair.
How Does Off Loading Help?
Off loading is simply removing pressure from an area for at least a minute at a prescribed frequency. When we shift our bodies at night in bed, we are performing the same function. Off loading allows blood to return to a compromised area.
Most patients with off loading orders are unable to move for themselves, so nursing staff assists them in maintaining skin health. In addition to bed-ridden patients, those confined to wheelchairs may need to off load periodically to prevent bedsores from developing on their buttocks and legs.