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Bedsores: Are they Preventable?

Bed Sores - Decubitus Ulcers - Pressure Sores Stage 4 Four

Has a family member developed bed sores or decubitus ulcers? Nursing Home Neglect can include failing to prevent bedsores. Elderly patients must be moved and turned frequently so that bed sores don't develop. Ulcers left untreated can victimize the elderly patient and even cause wrongful death. Decubitus Ulcers are very often caused by a Nursing Home's inexcusable failure to turn a patient frequently.

There are several stages of Decubitus Ulcers with stage 4 being the most serious/advanced. Pressure Sore Death can occur if a stage 4 bed sore decubitis ulcer is allowed to advance to infection and aggressive treatment is not successful. Most pressure sores are easily preventable. Our attorneys can review your nursing home medical records to determine if the nursing home has acted negligently in treating pressure sores.

Pressure Sore Stages:

The Federal Goverbnment has issued regulations that basically require nursing homes NOT to allow a resident who enters a facility
to acquire pressure ulcers while under their care:
§483.25(c) Pressure Sores (also called Tag F314):
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.

The National Pressure Ulcer Advisory Panel (NPUA) has published their definitions of Pressure Ulcers (updated in 2007):
Pressure Ulcer Definition
A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony
prominence, as a result of pressure, or pressure in combination with shear and/or friction.
Pressure Ulcer Stages
Stage I:
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 II:
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 III:
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 IV:
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar 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.

Contrasted with a Pressure Sore is a different skin injury called a Deep Tissue Injury, defined by NPUA as:
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of
underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is
painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.
Further description: According to the NPUA, Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may
include a thin blister over a dark wound bed. The wound may further evolve and become covered
by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

The Federal regulations and guidelines list the classic risk factors for bed sores -
• Impaired or decreased mobility and decreased functional ability
• conditions such as end-stage renal disease, thyroid disease, or diabetes mellitus
• Use of drugs like steroids that may affect wound healing
• Impaired blood flow, ie, atherosclerosis or arterial insufficiency
• Refusal of care
• Cognitive impairment
• Exposure of skin to urinary and fecal incontinence
• Under-nutrition, malnutrition, and hydration deficits
• recurrence of prior ulcer

Pressure ulcers develop when capillaries supplying the skin are compressed enough to impede perfusion, leading ultimately to tissue necrosis.
Though rarer, pressure ulcers can develop within 2 to 6 hours.

Assessment Tools: Both the Braden and Norton scales help to measure Pressure sore risks. The Norton Scale consists of five
components: physical condition, mental condition, activity, mobility, and incontinence. The pressure ulcer prevention protocol consisted of preventive
interventions with implementation of support surfaces and turning/repositioning residents. Keeping the skin clean and dry will prevent excessive moisture
that may increase skin breakdown. CMS recommends the following five parameters be included: skin temperature, color, turgor, moisture status, and integrity.

Interventions such as frequent repositioning are critical in preventing pressure ulcers as well as treating ulcers.

Our Boston area Law office represents victims of Nursing home Abuse and Neglect. If your loved one has been injured or died as a result of nursing home abuse or neglect please call our Massachusetts attorneys at 1-617-479-4300 or use our free case evaluation form below: