Pressure Ulcers (Bedsores, Pressure Sores) in Nursing Homes and Hospitals
Approximately 60,000 patients die from pressure ulcer-related complications each year, a 2009 report found. Pressure ulcers, also known as bedsores or pressure sores, affect a large number of bedridden patients, and they can serve as a sign of subpar care in hospitals or nursing homes.
What is a Pressure Ulcer?
A pressure ulcer is an area of the skin that breaks down due to consistent rubbing or pressing against the skin, according to the The U.S. National Library of Medicine. This constant pressure reduces blood flow to the affected area, and without enough blood flow the skin can die. The ulcer is a soft tissue injury, generally caused by sitting or lying down in one spot for an extended period of time.
Pressure ulcers, commonly called bedsores, are a serious medical condition that can be very painful and lead to other infections.
They are often found on the:
- back of head
Nearly 159,000 nursing home residents suffered from pressure ulcers in 2004, according to the Centers for Disease Control and Prevention. Between 1993 and 2006, the number of patients with pressure ulcers increased by over 75%, nearly 5 times the increase of overall hospitalizations. Pressure ulcers are most common among residents age 65 and older, especially among those who are in the nursing home or hospital for less than a year. Pressure ulcers are the second-most common hospital-acquired condition, accounting for over 28% of all hospital-acquired conditions.
Pressure ulcers are categorized based on their severity, with Stage I being the earliest and Stage IV the most severe stage:
- Stage I: A reddened area on the skin that does not turn white when pressed; this is a sign that a pressure ulcer is developing.
- Stage II: The skin begins to blister or form an open sore; the area surrounding it may be red and irritated.
- Stage III: The skin develops an open, sunken hole (called a crater); there is damage to the tissue beneath the skin.
- Stage IV: The pressure ulcer is deep and there is possible damage to the muscle, bone, tendons, and joints.
The National Pressure Ulcer Advisory Panel added two additional stages in 2007 to account for deep tissue injury and unstageable ulcers.
If pressure ulcers are not noticed and treated in the early stages, various other medical conditions can develop. Chronic pressure sores can turn into squamous cell carcinoma, a type of cancer that typically requires surgery. Joints and bones can become infected, also knows as septic arthritis, which can damage cartilage and tissues, as well as inhibit joint functions. Open pressure sores can allow bacteria to enter the patient’s bloodstream, leading to sepsis and organ failure. Untreated bedsores can also lead to cellulitis, in which connective tissues become inflamed and possibly develop meningitis.
In addition to the physical and emotional impact of pressure sores, the financial burden can be extreme. A 2009 report estimated that the cost of treating pressure ulcers is between $9.2 billion and $15.6 billion annually.
Are Pressure Ulcers a Sign of Neglect?
The short answer: maybe. It depends on the severity of the pressure sore, as well as the patient’s overall health and regimen.
The majority of pressure ulcer sufferers develop Stage II pressure ulcers, which have not yet damaged the tissue below the skin. But Stage III and Stage IV pressure ulcers can be a sign that medical staff are not paying close attention to patients.
The U.S. Centers for Medicaid and Medicare Services labeled full-thickness pressure ulcers (stages III and IV) as “never events” back in 2007. In other words, these kind of ulcers are reasonably preventable and should never occur.
The vast majority of pressure ulcers are avoidable with simple nutrition and lifestyle standards. Attentive hospital and nursing home staff should watch closely when caring for patients who are susceptible to pressure ulcers.
Nursing home and hospital staff should know that these factors are at an increased risk for bedsores:
- Patients over 65, who experience reduced capillary blood flow and reduced fat beneath the skin
- Conditions that affect mobility, such as spinal cord injuries, sedation, cognitive impairment, and prolonged hospital stays
- Exposure to skin irritants, sometimes due to incontinence
- Impaired capacity for wound healing, often due to undernutrition, diabetes, or arterial disease
The National Pressure Ulcer Advisory Panel Consensus Conference found that most medical professionals—across disciplines—believe bedsores are generally avoidable, barring a patient condition that prohibits quality nutrition or movement.
As a pressure ulcer develops and moves into more aggressive stages, the chances of infection increase and the chances of a full recovery decrease. After six months of treatment, 70% of Stage II pressure ulcers resolve, but only 50% of Stage III and 30% of Stage IV pressure ulcers resolve.
How Can You Prevent Pressure Ulcers or Bedsores?
Pressure ulcers can be caused or exacerbated by a lack of patient autonomy or a lack of ability to move around. The best ways for medical professionals to prevent pressure ulcers are to:
- frequently change the resident’s position (ideally every two hours)
- provide proper nutrition
- use soft padding to reduce pressure on the affected area
- only restrain patients when medically necessary, and do so under careful supervision
- instruct patients to drink plenty of water (8-10 cups every day)
- encourage daily exercise, including range-of-motion exercises
- keep the skin clean and dry
Using pressure-relieving bedding materials is very effective in preventing pressure ulcers, according to a study produced for the Agency for Healthcare Research and Quality.
If you or a bedridden loved one discover a pressure ulcer, immediately alert the caregiver or attending nurse. Relieve the pressure on the area using pillows, special foam cushions, or sheepskin. Avoid further injury or friction, and powder the sheets lightly with a doctor-approved product.
Eating healthy foods and cleaning the ulcer correctly is very important in halting the ulcer’s development and preventing skin damage. If you or a loved one develop additional ulcers, tell medical staff as soon as possible.
Have You Or a Loved One Suffered From Pressure Ulcers?
Nursing home abuse and elder abuse are serious breaches of caregiver-patient trust. If you suspect a loved one was abused or neglected in a medical facility, leading to the development of pressure ulcers, contact Maggiano, DiGirolamo & Lizzi as soon as possible. Call today at 201-585-9111 for a free consultation with our nursing home abuse and neglect attorneys in nursing and geriatric medicine.