Bed
Sores
What are pressure sores / bed sores? AKA: Decubitus Ulcers, Pressure Ulcers, Dermal Ulcers, Pressure Wounds
A bed sore or pressure sore is an injury to the skin and underlying tissue. Bed sores are ulcers that occur on areas of the skin that are under pressure from lying in bed or sitting in a wheelchair. Once a bed sore develops, it is often very slow to heal. They can be very painful and result in severe complications, such as infection in the bone or blood. Bed sores can result in death.
Why does a bed sore develop?
Bed sores are caused when there is too much pressure to an area of the body and usually are found on the hips, heels or tailbone. Constant pressure on the skin reduces blood supply to the skin and oxygen and nutrients carried by the blood cannot reach the cells in the tissue, eventually causing cell death. Blood supply to the skin can be cut off after two to three hours from constant unrelieved pressure. As the skin dies, the bed sore first starts as a red, painful area, which eventually turns purple. Left untreated, the skin can break open and become infected. A bed sore can become deep, extending into the muscle.
Pressure sores occur most frequently in patients who are unable to walk, move or turn over in bed on their own. People who are unconscious, unable to sense pain, in wheelchairs or those who stay in bed are especially susceptible because are unable to shift their weight without assistance. Unless immobile elderly nursing home patients are repositioned frequently, they may develop bedsores.
Proper nutrition is also necessary to prevent skin breakdown. Other causes may include friction, which is the rubbing that occurs when a person is pulled across bed sheets or other surfaces, and shear, which is movement (such as sliding down a chair) that causes the skin to fold over, cutting off the blood supply and possibly causing pressure sores.
Can bed sores be a sign of nursing home neglect?
Bed sores may be a sign of assisted living facility or nursing home neglect or nursing home abuse. Bed sores are unacceptable and can be prevented by changing a person’s position frequently and by making sure patients have adequate nutrition. “A patient develops a pressure ulcer because, at some point, he or she had inadequate pressure relief.” claims Dr. Kenneth Olshanski, a clinical professor of plastic surgery at Virginia Commonwealth University-Medical College of Virginia, Richmond. According to Dr. Olashanski, if a patient develops an bedsore in the course of his or her stay in a hospital or nursing home, then “the nursing staff [or doctor] fell down on the job, pure and
simple.”[1]
Bedsores are one of the required indicators of quality of care measured and reported by nursing homes to participate in the Medicare and Medicaid
programs.[2]
Preventing bedsores requires time, effort and adequate staffing. Nursing homes that accept severely ill patients who either have or are at severe risk for developing pressure sores must be equipped to provide the skilled care – including tube feeding, catheterization, and frequent turning and positioning – necessary to prevent or treat them. When an assisted living facility or nursing home accepts residents whose need or acuity levels exceed the staff’s skill or training then it can be liable for nursing home neglect. If you or a loved one has been a victim of nursing home neglect, please contact
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Sources:
Decubitus Ulcers: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: Icon Health, 2004.
Hess, Cathy Thomas. Clinical Guide to Wound Care. Philadelphia: Lippincott, Williams & Wilkins, 2002.
U.S. Department of Health and Human Services. Treatment of Pressure Ulcers. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1994.
http://www.paralysis.org/Health
http://jama.ama-assn.org/
Pressure Sores: Part I “An Incurable Malady?” PN (Paraplegia News). June 2002 pp 13-17.
Lyder, Coruney H., Pressure Ulcer Prevention and Management, JAMA 2003, 289; 223-226
[1] Olashnski M.D., Kenneth PRESSURE ULCER RISK ASSESSMENT SCALES--THE MISSING LINK, Advances in Wound Care 22 (2):90, 1998 Springhouse Corporation
[2] http://www.medicare.gov/NHCompare/
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