Federal Guidelines Require Nursing Home Residents Sitting in Chairs to be Repositioned At Least Every Hour

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Nursing home residents may be 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 sore/decubitis ulcer is a bedsore that comes from lying or sitting in the same position too long and is associated with pain.  These pressure sores are generally avoidable so long as the nursing home staff: (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 order to comply with the minimum standards of care, nursing homes must: (1) ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were unavoidable; and (2) ensure that a resident having pressure ulcers receives necessary treatment and services to promote healing, prevent infection and prevent new ulcers from developing.  This includes turning and repositioning the resident at least every two hours while in bed.

Nursing home residents are often placed in chairs (including wheelchairs or Geri-chairs) for long time periods and even allowed to nap in these chairs for hours at a time.  Sitting residents experience more pressure to their buttocks area than they would experience if lying down, preventing the blood from flowing into those points.  Pressure must be relieved by turning or repositioning such residents more frequently than residents lying in bed.

The federal government has developed clinical practice guidelines requiring residents who are sitting to be repositioned at least every hour.  According to Clinical Practice Guideline Number 15 for Treatment of Pressure Ulcers published by the United States Department of Health and Human Services in December of 1994:

While Sitting.  Interface pressure may be particularly high over sitting surfaces.  When a pressure ulcer has formed on such a surface, the individual should avoid sitting.  If pressure on the ulcer can be totally relieved, the person can sit for a limited time.  Proper postural alignment, distribution of weight, balance, stability, and continuous pressure relief are important positioning considerations for the sitting individual.  A written plan for the use of positioning devices should be developed and implemented.  An individually prescribed seat cushion should be used and donut-type devices should be avoided.  Sitting individuals should be repositioned at least every hour and should shift their weight every 15 minutes if possible.  If hourly repositioning is not feasible, the individual should be returned to bed.

(Emphasis added).

Unfortunately, in our cases, we have encountered situations where nursing home residents were allowed to sit for hours at a time without being repositioned and pressure sores developed.  Once a bedsore/pressure ulcer/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.   

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 October 28, 2011 11:25 AM.

Nursing Home Neglect Claim Against Facility's Director of Nursing in Maryland Bedsore (Decubitus Ulcer) Cases was the previous entry in this blog.

Legionnaire's Disease in Long-Term Care Facility Settings -- Recent Death of Resident of the Lighthouse Senior Living Facility in Howard County, Maryland is the next entry in this blog.

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