What are Bedsores?
A bedsore, also called a pressure injury, pressure ulcer, decubitus ulcer, or pressure sore, develops when continuous pressure to certain areas of the body begin to break the skin down due to decreased mobility. Bedsores are commonly found on bony projections of the body, such as the sacrum, which is a triangular bone at the base of the spine and at the upper, back part of the pelvic cavity. Pressure injuries can also develop underneath casts, splints, or cervical collars. Approximately 60 percent of bedsores develop in the pelvis area. They are a source of pain and discomfort for some Georgia nursing home residents and a major health threat to elderly or disabled people who have a chronic disease or restricted mobility.
The National Pressure Ulcer Advisory defines pressure injuries as “localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other devices. The injury can present as intact skin or an open ulcer, may be painful, and occurs as a result of intense and/or prolonged pressure, or pressure in combination with shear.”
Shear: “An action or stress resulting from applied forces which cause or tends to cause two contiguous internal parts of the body to deform in the transverse plane.”
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*WARNING! Graphic Photos may be disturbing to some*
Causes of Bedsores: Who is at Risk?
Many elements contribute to bedsores, but they usually develop over prolonged periods of immobility or uninterrupted pressure on a certain area of the skin, soft tissue, muscle and bone. The following circumstances make people more at risk for developing bedsores:
- Being bedridden
- Being confined to a wheelchair
- Stroke victims
- Moisture or incontinence (more study on this is needed)
- Spinal cord injuries resulting in Paraplegia
- Poorly fit prosthetic devices
- Chronic understaffing
WE PROSECUTE NURSING HOMES AND LONG-TERM CARE FACILITIES FOR ABUSE AND NEGLECT. IF YOU OR YOUR LOVED ONE HAS A BEDSORE AND SUSPECT ABUSE OR NEGLECT, CONTACT US TODAY AT (706) 354-4000
Stages of Bedsores
There are five main stages of pressure injuries: Stages 1-4 and Unstageable. Treatment of bedsore varies depending on what stage the sore is scaled. It’s a long-term care facility’s responsibility to identify a pressure sore, scale it properly, and provide adequate medical care and treatment to keep it from worsening. When a pressure injury develops beyond stage 4, it is considered unstageable and is dangerous to a person’s health because it’s susceptible to infection. An unstageable bed sore may lead to death.
Preventing Bedsores: What Georgia Nursing Homes Should be Doing
Direct pressure from infrequent position changes is the leading cause of pressure injuries. Caregivers should continually monitor bedridden or immobile residents to ensure they aren’t in the same position for long periods of times. Bedsores are extremely painful and can lead to infection and death, but chronic understaffing prevents caregivers from offering residents the proper care and attention they deserve.
Residents of Georgia nursing homes should always be evaluated under The Braden Scale or Norton Scale, which are two tools used by professionals to determine who is at risk for developing pressure injuries. The Braden Scale is more commonly used in long-term care facilities. Six subscales measure sensory perception, skin moisture, physical activity, nutritional intake, friction and shear, and ability to change and control body position. Patients or residents who score a 12 or lower on the Braden Scale are considered at high or severe risk of developing bedsores.
Some other preventative measures include:
- Proper staffing
- Gently moving a resident’s position every couple of hours while in bed
- Gently adjusting wheelchair-bound patients every 15-30 minutes
- Good hygiene
- Clean skin with gentle/mild soap
- Don’t scrub too hard
- Dry skin immediately after bathing or incontinence
- Change soiled clothes immediately and use a protective barrier cream or pads for incontinence
- Apply gentle lotions and creams to keep skin soft
- Healthy diet (malnutrition is associated with delayed healing, infection and slow recovery, so a healthy diet is crucial in both preventing and caring for bedsores. If a patient has trouble consuming enough calories or nutrients, incorporate a nutrition shake)
- Avoid tobacco and alcohol
Best Way to Treat a Bedsore
If bedsore has already formed, it’s the long-term care facility’s responsibility to diagnose and treat it. How a pressure sore is treated is based on what stage it is. Here are some examples of what Georgia nursing homes should be doing to care for bed sores that have already formed.
- Keep the sore clean
- Change the bandages frequently
- Keep it covered
- Keep it slightly moist
- Treat pain as needed
- Continue gently moving and adjusting the patient’s position
- Depending on the stage, antibiotics may be needed to fight infection
- Surgical intervention may be needed for pressure injuries in a stage 3 or higher
Nursing Home Abuse and Neglect: Bed Sores
You may be wondering whether bed sores are a sign of nursing home abuse or neglect. While not all cases are, some shouldn’t be dismissed. If proper care isn’t taken to evaluate residents correctly and bedsores go undiagnosed or untreated, it’s considered negligence. If left undiagnosed or untreated, a pressure sore can be harmful, even deadly. Deviations from the standard of care or negligence for residents also include:
- Failure to meet proper staffing guidelines, which directly correlates with quality of care
- Failure to properly treat a bedsore
- Failure to properly asses or scale a bedsore
- Failure to modify or change a plan of care when a bedsore develops
Doctors, nurses, certified nursing assistants (CNAs) and other staff employed by nursing homes and hospitals have a duty to meet the national standard of care when diagnosing and treating pressure injuries. For instance, the standard of care requires that nurses assess, diagnose, plan, and evaluate every patient on every shift. The standard of care also requires patients be evaluated using the Braden or Norton scales for their risk of skin breakdown by assessing each of the six subscales.
The standard of care further requires nurses and staff be knowledgeable about wound care prevention, diagnosis, and treatment through continuing education. Nurses and CMAs are also required to implement interventions and treatments that doctors order for each patient.
When doctors and nurses, CNAs, and other staff deviate from the standard of care, it is harmful to the overall health of the patient or resident, and in some cases, may be deadly. Bedsores adversely affect the quality of life for residents of nursing homes, which is a basic right under federal and state law.