Avoid Pressure Sores / Decubitus Ulcers/ Pressure Injury
How do you help avoid pressure sores or ulcers in nursing home residents? One of the most prevalent forms of preventable elder abuse and neglect, often called decubitus injury ulcer, pressure ulcer or bed sores. Pressure sores are usually an indication that the nursing home staff is not assisting the residents to move freely or not turning them as often as necessary. The 42 CFR 483. Nursing Home Regulationswhich regulations Nursing Homes considers pressure sores to Be “AVOIDABLE” and therefore preventable:
Pressure injury ulcers / sores. Based on the comprehensive assessment of a resident, the facility must ensure that— (1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and (2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. 42 CFR 483. Nursing Home Regulations
Understanding Pressure Sore Injuries – Bed Sores
Pressure sores also referred to as decubitus ulcers and as of April 2016 as considered pressure injuries are areas of damaged skin and tissue that develop due to a reduction in circulation often accompanied by excessive periods of unrelieved pressure on the affected area. In order to properly track the care provide for a pressure sore, it is essential that the staff understand the correct way to identify and chart the stages of pressure sores. National Pressure Ulcer Advisory Panel The National Pressure Ulcer Advisory Panel (NPUAP) serves as the authoritative voice for improved patient outcomes in pressure ulcer prevention and treatment through public policy, education and research.
Pressure Injury Ulcer Stages Revised by NPUAP Pressure Ulcer Image Library Stages of Pressure Ulcers In April 2016, the National Pressure Ulcer Advisory Panel has redefined the definition of a pressure ulcer and the stages of pressure sores, including the original 4 stages and adding 2 stages on deep tissue injury and unstageable pressure ulcers.
Stage 1: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. Further description: The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk)
Stage 2: Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Further description: Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation. *Bruising indicates suspected deep tissue injury
Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Further description: The depth of a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible or directly palpable.
Stage 4: Full thickness tissue loss with exposed bone, tendon or muscle. Slough or Pressure Ulcer Prevention may be present on some parts of the wound bed. Often include undermining and tunneling. Further description: The depth of a stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable.
Unstageable Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Further description: Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.
For more information see npuap.org. This organization is an excellent resource for caregivers and family members dealing with individuals that are at risk for pressure sores. Bed sores are not always preventable but, in most instances, a nursing home staff should be aware of the pressure and wound building up around the area. It is the nursing staff’s duty to ensure that the elderly are looked after and this means ensuring they are moved and taken care of if the first stage of bed sores are present.
Pressure ulcers are “preventable” in most situations. Make sure your loved on is getting the proper care including:
• Proper Hydration and Nutrition;
• Is getting turned or rotated every 2 hours if unable to get up from bed or from wheel chair;
• Sheets are keep clean and smooth (without wrinkles); • A special pressure relieving mattress or wheel chair cushion is used;
• All wounds should be measured and evaluated (Staged from 1-4) using the “Braden Scale” or similar method;
• Wounds are immediately addressed in the early stages and appropriate wound care is performed by a qualified professional, including the use of wound vac devices and other methods to reduce the size and degree of the ulcers. Questions to ask the Nursing Home regarding Pressure Sores: • Request Nursing Home Policies regarding Pressure Sores.
• Was the sore acquired at the facility?
• Has the resident been assessed for Skin Breakdown Risks, what is the Braden scale staging? (Stages 1-4)?
• Does the nursing home have photos of the wound? • Has the resident’s family and physician been notified that there is an ulcer?
• What was the resident’s treatment plan / care plan for the ulcer. Was there wound care? • Was the wound care provided by the facility or outsourced?
Please note that this article is for educational purposes. If you have a legal question contact a lawyer directly for a legal opinion.
If you notice your loved one has pressure injury sores, then it should act as a warning sign that the nursing staff may not be provided adequate health and personal care. You should contact a nursing home neglect attorney immediately to discuss how to hold the nursing home accountable.
Attorney Kenneth L. LaBore has years of experience handling nursing home abuse and neglect cases and can assist you in determining if there is a claim related to preventable pressure sores. For a free consultation call 612-743-9048 or toll free at 1-888-452-6589 or fill out the form on this page to discuss your nursing home rights and your legal options. Email: KLaBore@mnnursinghomeneglect.com