Bed Sores and Pressure Ulcers

Bedsores, also known as pressure ulcers occur if a patient lays or sits in one position for an extended period of time. Placing pressure on a particular side or area of the body disrupts the flow of blood to the tissue, which leads to tissue death. Inadequate nutrition during an acute or chronic illness increase the risk that pressure ulcers will develop because lack of protein impairs the integrity of the skin and interferes with usual healing mechanisms.

Pressure ulcers develop in stages:

NPUAP-stage1Stage 1

Redness of the skin surface that does blanch when pressure is removed.If preventative measures are implemented at this time (most significantly, pressure relief and keeping the area dry), Stage 1 ulcers will heal.

NPUAP-Stage2Stage 2

Broken area in the skin that does not penetrate through the fat layer. If preventative measures are implemented at this time (most significantly, pressure relief and keeping the area dry) Stage 2 ulcers will heal.

NPUAP-Stage3Stage 3

A wound that penetrates into the fat layer. It is imperative at this stage that meticulous pressure relief is provided as well as ensuring the area is dry, consistent provision of appropriate wound care and nutritional support. A pressure ulcer of this severity usually exceeds the capabilities of most nursing and medical staff to handle without the input of a certified wound care provider. Thus, a wound care consult is almost always indicated at this stage.

NPUAP-Stage4Stage 4

A wound that has penetrated through the fat layer into the muscle and bone. A Stage IV ulcer must be debrided and often requires surgical skin and muscle grafting to heal in combination with meticulous pressure relief, wound care and nutritional support. A prolonged period of healing time (sometimes 2 years or more) can be expected. If an individual with many comorbities or other illnesses develops a Stage 4 pressure ulcer, a systemic infection will often develop and it is usually fatal.

NPUAP-Unstage2Unstageable

This refers to full thickness tissue loss in which the base of the wound bed has not been exposed so the stage cannot be determined. Sometimes an unstageable pressure wound describes a situation where the base of the ulcer is completely covered by slough and/or eschar in the wound bed. Sometimes, an unstageable pressure wound describes a localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. In either case, unless the damaged tissue/slough/eschar is removed to expose the base of the wound, the true depth and stage of a pressure wound assessed as unstageable cannot be determined.

Pressure ulcers are usually preventable with proper nursing care. In fact, any stage 3, stage 4, or unstageable pressure ulcers acquired after admission/presentation to a health care facility has been placed on the list of “Never” events compiled by the Center for Medicare Services (“CMS”). This list identifies common complications that CMS believes are always preventable and should never occur. If a condition is on the list of CMS “Never” events, it has the right to with hold payment to a provider for that treatment.

Pressure ulcers usually occur in the elderly or in individuals who because of an acute illness are unable to adequately intake nutrition and unable to sense that their body needs to be repositioned. This inability to change position places the patient at high risk to develop a pressure ulcer if the nursing staff is not vigilant and does not ensure repositioning occurs every 1-2 hours. Pressure ulcers often occur in the vulnerable elderly population, who depend on nursing staff at hospitals, nursing homes, and long-term care facilities to meet their mobility and nutritional needs.

The State of Texas requires that all patients have an individualized plan of nursing care implemented at the time of admission to any healthcare facility that addresses their identifiable health needs. All facilities have policies that address the assessment required to determine if an individual has skin breakdown or has the potential for skin breakdown. All facilities have policies that address what interventions should be put into place to prevent skin breakdown, or to keep it from worsening if it is already present.

It is our experience that most pressure ulcers develop because the nursing staff does not follow the facility policies for the assessment of the risk for skin breakdown, or the treatment of skin breakdown once it is noted. They do not follow these policies either because they have not been trained on the policies, or there is insufficient staff to allow them to do so.

Pressure ulcers are incredibly painful, as the sore deteriorates through living tissue. Treatments are also very painful, as they involve removal of death tissue so that living tissue can fill in the wound, either through chemical debridements of physical debridements where dead flesh is actually cut out of the wound. Sometimes surgery is necessary to cut out the dead tissue and place a muscle or a skin graft. Like any other open wound, pressure sores are an easy entry point for bacteria and life threatening infections can develop.

If you or a loved one has or is suffering from a Stage III or IV pressure ulcer as a result of the failure to receive standard preventative measures, contact Wormington & Bollinger today. We serve those who have suffered preventable medical complications throughout the State of Texas. We are committed to helping you investigate the cause of this injury, to determine who is responsible, and to lessen the financial burden it has imposed on you and your family.