Pressure ulcers or decubitus ulcers, commonly referred to as bedsores, are serious and sometimes fatal injuries typically afflicting the elderly, bedridden and wheelchair populations including stroke victims, paralysis and dementia patients. Most bedsores occur in hospital or nursing home settings. With proper care and prevention, however, the risk of bedsores and resulting complications can be greatly reduced, if not eliminated, for at-risk patients.

What is a pressure ulcer or bedsore?

A pressure ulcer or bedsore is as an area of unrelieved pressure in a defined area, usually over a bony prominence (such as the tailbone, ankle or elbow), resulting in ischemia, cell death, and tissue necrosis. Essentially, the pressure prevents blood from getting to the tissue, which breaks down and eventually dies. Once a bedsore develops, depending upon age, nutrition and other medical factors, the skin may not heal and a life-threatening systemic infection can result. Risk factors for pressure ulcers include inactivity, immobility, diabetes, advanced age, impaired cognition, and bowel or bladder incontinence.

Pressure ulcers are classified and treated according to clinical “stage” based on certain criteria. Assigning a pressure ulcer stage is based on visual inspection to determine the extent of tissue destruction and wound depth. Pressure ulcer staging also requires an understanding of the anatomy of skin and underlying tissues. In stage I, the skin is not broken but is red or discolored without fading thirty (30) minutes after pressure is removed. By stage II, the topmost layer of skin is broken, creating a shallow, open, painful sore.  A stage III pressure ulcer is a full-thickness skin loss involving damage or necrosis of the underlying tissue that may extend down to, but not through, muscle or bone. Drainage may or may not be present in stage II and stage III pressure ulcers. Stage IV describes a pressure ulcer involving extensive destruction of tissue with tissue necrosis or damage to muscle, bone, or supporting structures. Usually, dead tissue and drainage are present in stage IV pressure ulcers.

According to the National Quality Forum, a non-partisan consortium of healthcare professionals and organizations, stage III and IV and unstageable pressure ulcers that develop after admission to a facility are considered Serious Reportable Events (SRE) that are preventable and should never occur. Unfortunately, bedridden, wheelchair bound and other at-risk patients don’t always receive the necessary care to prevent pressure ulcers. All too often, infected pressure ulcers lead to systems failures and ultimately death for at-risk patients at hospitals, nursing homes, acute and long-term care facilities. According to the National Pressure Ulcer Advisory Panel, a non-profit devoted to the prevention and care of pressure ulcers, each year approximately 2.5 million patients are treated for pressure ulcers in U.S. acute care facilities and as many as 60,000 U.S. hospital patients die each year from pressure ulcer complications.

Causes and prevention of bedsores

Pressure ulcers or bedsores are commonly caused by a combination of four factors: pressure, shearing forces, friction and moisture. The key to prevention is pressure reduction.

Good skin care begins with an initial risk assessment and the creation of a skin care plan specifically tailored to the patient’s condition and setting. Prevention of skin breakdown, pressure ulcers and tissue or blood infections is an essential aspect of care. Upon admission to a hospital, acute care or other facility, patients should be evaluated by a physician, qualified nurse of other medical professional for the risk of skin breakdown taking into account numerous variables and risk factors. Thereafter, regular skin assessments should be performed on a regular basis (daily in an acute care setting), especially if a skin problem is suspected or has been observed. Initial and periodic assessments should contain accurate measurements of the length, width, and depth of a wound. Drainage type, color and odor, and the color of wound tissue should be noted, as well as staging of the wound.

At a minimum, patients identified as at-risk for skin breakdown should be repositioned at least every two (2) hours. However, regular repositioning may not be enough for patients at higher risk levels or if a pressure ulcer has already formed. A pressure-reducing surface like a foam or inflatable mattress cushion should be used for those patients. To minimize the risk of skin breakdown from shearing forces, the head of the bed should be maintained at the lowest degree of elevation necessary based on medical conditions and other factors. Friction injuries may be reduced by the use of protective dressings and barriers. Pressure ulcers must be kept clean, dry and protected from sources of contamination such as feces and urine. This typically requires frequent cleaning of the patient and changing of the wound dressing.

What to look for?

Pressure ulcers can develop quickly – within days or even hours – depending on a patient’s condition and setting. The most common site where pressure ulcers occur in bedridden patients is the buttocks area, over the tailbone. Because of this, developing bedsores may be difficult to detect for family members not involved in the daily care of a patient. There are, however, certain observable factors and symptoms might indicate the presence of a bedsore warranting further examination and treatment. They can include:

• lengthy period of immobility
• generalized or local discomfort or pain when not being moved or touched
• generalized or local discomfort or pain when being repositioned, turned, or moved
• foul odor from of undetermined origin
• evidence of lack of proper turning or re-positioning
• poor hydration and/or nutrition
• lack of proper hygiene and cleaning of incontinent patients

What to do?

If you suspect that a family member or loved one is at-risk or suffering from a bedsore, you should immediately notify the healthcare professionals in charge of their care. Proactive oversight and management of your loved one’s care is the best way to ensure they are receiving the proper care.

If your loved one is the victim of negligent care resulting in a pressure ulcer or decubitus, contact the experienced Atlanta Georgia elder care, bedsore and medical malpractice attorneys at Brownstein & Nguyen today for a free consultation. We handle cases involving preventable bedsores and the serious health complications and deaths that result. We’ll confidentially review the case, and discuss your legal rights with you.