Nursing Home Bed Sores / Pressure Ulcers / Decubitus Ulcers -- Important Findings of the United States Centers for Disease Control and Prevention

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Patients residing in nursing homes may be at risk of developing bed sores (also known as pressure sores or decubitus ulcers) as a result of their underlying health problems and immobility issues.  A pressure sore/decubitus ulcer is a bed sore caused by unrelieved pressure on the skin that comes from lying in the same position too long and is associated with pain.    Nursing home patients experience pressure from their bed and/or chair to certain points on their skin 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.

The United States Centers for Disease Control and Prevention ("CDC") published a paper in February of 2009 entitled "Pressure Ulcers Among Nursing Home Residents: United States, 2004" concluding that "pressure ulcers are serious and common medical conditions in U.S. nursing homes, and remain an important public health problem."  This paper contained the following key findings and conclusions that are worth repeating.

-Overall, about 159,000 United States nursing home residents, or 11% of nursing home residents, had pressure ulcers in 2004.  

-Various demographic and clinical factors were related to having a pressure ulcer in a nursing home.  Residents who had been in a nursing home for one year or less or who had recent weight loss, or who had high immobility had the highest prevalence of pressure sores.  Nursing home residents aged 64 and under were more likely than older residents to have pressure sores.  One-fifth of nursing home residents with a recent weight loss had pressure sores. 

-Only 35% of those nursing home residents with stage 2 (or higher) pressure sores, received special wound care services.  According to the CDC, this suggests that a minority of nursing home residents with stage 2 (or higher) pressure sores received proper wound care in accordance with clinical practice guidelines.    

The standard of care applicable to nursing homes requires the nursing home staff to ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were medically unavoidable.  The nursing home staff must also ensure that a resident having pressure ulcers receives necessary and proper wound care treatment and services to promote healing, prevent infection and prevent new ulcers from developing.  The nursing home staff must relieve pressure by turning and repositioning the resident at least every two hours while in bed and every hour while in a Geri-chair or wheelchair, maintain adequate nutrition and hydration, and prevent contractures of the extremities.

A stage 1 ulcer presents as redness of the skin without a break in the skin and represents tissue injury that does not disappear when pressure is relieved.  A stage 1 ulcer is classified as nonblanchable erythema with intact skin.  Erythema is redness of the skin produced by congestion of the capillaries.  Erythema is the initial reactive hyperemia caused by pressure, and nonblanchable erythemia represents stage 1 pressure ulcer.

A stage 2 ulcer is characterized by partial-thickness skin loss, that is, the epidermis is interrupted as an abrasion, blister or shallow crater.

A stage 3 ulcer features full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia.  The ulcer appears as a deep crater, with or without undermining of adjacent tissue. 

A stage 4 ulcer involves full-thickness skin loss (exposing bone or muscle) with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., a tendon or a joint capsule).

Unfortunately, once a bed sore has progressed to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and potentially fatal complications.   With stage 3 or stage 4 pressure sores, the extent of the disease may not be evident because of covering necrotic material or eschar.  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 be painful and life threatening.

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 even reimbursed for additional care resulting from bed sores as the government has determined that development of bed sores at a hospital is a so-called "never event."

Please feel free to contact the nursing home neglect attorneys 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 or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

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This page contains a single entry by David Feldstein published on August 11, 2009 6:08 AM.

Maryland Nursing Home Wrongful Death and Survivorship Lawsuits was the previous entry in this blog.

Nursing Home Falls -- Resulting Traumatic Head and Brain Injuries Require Immediate Medical Attention is the next entry in this blog.

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