Bed sores (also known as pressure sores and decubitus ulcers) are common ailments for nursing home residents, but that doesn't mean that they aren't serious or preventable. Pressure sores and bed sores are different terms to describe the same problem - the formation of a wound as a result of a particular part of the body being put under prolonged pressure. Bed sores can develop while the resident is lying in bed, sitting in a wheelchair or being otherwise immobile. Bed sores can be exacerbated by friction or excess moisture on the skin. Once formed, bed sores are very painful, can take months to heal and can complicate existing health problems. In the worst cases, they can actually become life-threatening.

Nursing homes have policies and procedures in place that address the prevention and treatment of pressure sores. Typically, the problem is not the quality of the policy, rather it is the quality of how the policy is implemented. In most cases, bed sores are indicative of a staffing problem at the nursing home, whether it is the number of staff members available to care for residents or the training staff members receive. The Terry Law Office has worked diligently for residents who have suffered from pressure sores as a result of negligence in nursing homes.

WHAT CAUSES PRESSURE SORES?

Simply stated, bed sores develop on the bony prominances of the body when there is continuous pressure on that area. Areas most at risk for pressure sores include the coccyx, hips, and heels, although other areas with unrelieved pressure are at risk as well. Immobile nursing home residents will likely develop bed sores if those charged with their care do not take consistent measures to reposition the resident and relieve the continuous pressure.

Cleanliness is a key factor in preventing and healing pressure sores as well. When a resident is forced to lie in her own waste for hours, the acidity of the urine tends to break down the skin. This breakdown can lead to the development or worsening of a pressure sore. When an existing pressure sore is subjected to urine and feces, there is the added danger of infection. Once a bed sore becomes infected, the resident is in grave danger of developing a systemic infection throughout her body known as sepsis. Sepsis is very difficult to treat and often results in death.

Another key factor in the prevention and healing of pressures sores is hydration and nutrition. When a nursing home is understaffed or the staff is poorly trained, some of the most basic necessities of life are overlooked. For example, many immobile residents rely entirely upon the nursing home staff to give them a drink of water or to assist with meals. When those basic staples are not accomplished, residents are at risk for becoming dehydrated and malnourished. Dehydration and malnourishment are two key components for the development of pressure sores.

HOW ARE PRESSURE SORES DIAGNOSED?

Pressure sores are classified according to stages and each stage of a bed sore represents a greater degree of tissue and skin damage than the stage before it. Pressure sores can develop quickly and can become a serious problem very quickly without immediate and aggressive treatment.

In February 2007, The National Pressure Ulcer Advisory Panel redefined the four stages of pressure ulcers:

	Stage 1: Skin that is intact but has non-blanchable redness that is typically localized to a specific area, usually over a bony prominence.  Skin with dark pigments may not show visible signs of blanching and its color could be different in the areas surrounding it.
	Stage 2:  Skin that presents with a partial thickness loss of dermis with a shallow open wound with a red pink bed without slough.  This sometimes also presents intact or as an open or ruptured fluid filled blister.
	Stage 3:  Skin tissue has full thickness loss.  The wound is open where subcutaneous fat is visible, however bone, muscle and tendon are not visible.  Slough may be present but not to the point of obscuring the wound depth.  Wound may have undermining or tunneling.
	Stage 4:  Wound is deep with full thickness tissue loss.  Muscle, tendon and bone are visible.  Eschar and slough may be present and undermining and tunneling are often present.

WHAT SHOULD NURSING HOMES BE DOING TO PREVENT PRESSURE SORES?

Without a doubt, pressure sores are easier to prevent than they are to treat, and nursing homes have many practices at their disposal to prevent pressures sores and to stop an existing pressure sore from worsening. For example:

• Residents should be well fed; well hydrated and kept clean and dry
• Any long-term care facility with aging residents should measure pressure sores weekly, or even more often. Other observations such as drainage, odor and the appearance of surrounding tissue shold be notated in the resident's medical record.
• Residents who use orthepedic devices such as braces should be provided with clothing or a protective pad to keep the appliance from rubbing on the resident's skin.
• Residents who are in wheelchairs and have adequate upper body strength should be taught "wheelchair pushups"- an excercize that allows the resident to alleviate pressure while they are sitting in the chair.
• Change the position of residents who are bed-ridden or in wheelchairs regularly. Bed-bound patients should be moved at least once every two hours.
• Special mattresses can help alleviate the threat of pressure sores, however these mattresses do not take the place of repositioning the patient every two hours.

HOW WE CAN HELP IF YOUR FAMILY MEMBER SUFFERS FROM BED SORES

We have been successful in cases where nursing homes have allowed residents to develop pressure sores. If a family member or loved one has suffered from a bed sore while under the care of a nursing home, contact Terry Law Office to discuss their injuries and legal rights.