Beware of the Geri-Chair -- Prevent Life Threatening Bedsores/Pressure Ulcers/Decubitus Ulcers With Frequent Turning and Repositioning

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Elderly nursing home residents are often at risk of developing bedsores (also known as pressure ulcers or decubitus ulcers) as a result of their underlying health problems and immobility issues.  A pressure ulcer/decubitis ulcer is a bedsore that comes from lying or sitting in the same position too long and is associated with pain.  These bedsores are generally avoidable so long as the nursing home: (1) provides proper preventative care (including turning, or repositioning, residents); and (2) develops, implements and (when necessary) updates a comprehensive care plan to prevent pressure ulcers from occurring and to prevent pressure sores from deteriorating.
 
In our experience, all too often the nursing home staff blindly follow the nursing home's  pre-printed medical forms when it comes to turning or repositioning residents.  The mentality seems to be that as long as the boxes on the pre-printed medical form are checked indicating the resident was turned or repositioned every two hours, the nursing home has satisfied their responsibilities to the resident.
 
In this regard, one trap that nursing homes fall into involves residents who are placed in geri-chairs.  Geri-chairs are a type of seating device that serve as a wheelchair and recliner.  It is not uncommon for nursing home residents to be placed in geri-chairs for long time periods and residents are often allowed to nap in these chairs for hours at a time.
 
Geri-chairs create even more pressure to a patient's buttocks area than the resident would experience if he or she was lying down, preventing the blood from flowing into those points.  Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection.  Pressure is a primary contributing factor to the development of pressure ulcers.  Pressure must be relieved by turning or repositioning the resident.
 
For these reasons, the federal government has developed federal regulations/clinical practice guidelines requiring that residents placed in geri-chairs be repositioned at least every hour.  The relevant regulation provides:
 
Any person at risk for developing a pressure ulcer should avoid uninterrupted sitting in a chair or wheelchair.  The individual should be repositioned, shifting the points under pressure at least every hour or be put back to bed consistent with overall patient management goals. 
 
(Emphasis added).
 
In our cases, we have encountered nursing homes that do not even have policies, procedures or guidelines for repositioning or turning residents in geri-chairs.  Oftentimes, the nursing home staff and medical director are not even aware of: (1) the increased pressure risk posed by geri-chairs; (2) or the above-referenced federal regulation requiring residents in geri-chairs to be repositioned at least every hour. 
 
Sadly, once a bedsore/pressure sore/decubitis ulcer develops, it can be difficult to reverse, become infected and quickly progress to a stage 3 or stage 4 decubitus ulcer.  A stage three ulcer involves full-thickness skin loss and damage or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia.  The ulcer appears as a crater, with or without undermining of adjacent tissue.  A stage four ulcer involves full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., a tendon or a joint capsule).
 
With stage 3 or 4 pressure ulcers, the extent of the disease may not be evident because of covering necrotic material.  To establish the extent of the disease and promote healing, the necrotic material needs to be removed and surgical consultation may be required.  When ulcers develop over bony prominences, osteomyelitis is a potential complication.  Pressure ulcers are chronically contaminated wounds and the combination of bacteremia and pressure sores can result in sepsis and death.   
 
The good news is that pressure ulcers are entirely avoidable so long as proper care and preventative measures are instituted and implemented by the nursing home.  Under new Medicare guidelines, hospitals are no longer reimbursed for additional care resulting from bed sores and several other "reasonably preventable" errors. The government has determined that development of bedsores is a so-called "never event."
 
Please feel free to contact the lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury as a result of bedsores/pressure sores/decubitus ulcers or elderly abuse or neglect. 

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This page contains a single entry by David Feldstein published on July 29, 2009 4:22 PM.

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