What Are Pressure Sores, also called Bed Sores or Decubitus Ulcers?
A pressure sore is a skin ulcer that is commonly called a “bed sore,” and medically called a “decubitus ulcer.”
It can range from a very mild pink coloration of the skin, which disappears in a few hours after pressure is relieved on the area, to a very deep wound extending to and sometimes through a bone into internal organs.
These ulcers, as well as other wound types, are classified in stages according to the severity of the wound.
All decubitus ulcers, pressure sores, and bed sores have a course of injury similar to a burn wound. This can be a mild redness of the skin and/or blistering, such as a first-degree burn, to a deep open wound with blackened tissue, as in a third-degree burn. This blackened tissue is called eschar.
How Are Bed Sores Formed?
A decubitus ulcer is formed by and through pressure. However, it can also occur from friction by rubbing against something such as a bed sheet, cast, brace, etc., or from prolonged exposure to cold. Any area of tissue that lies just over a bone is much more likely to develop a decubitus ulcer, pressure sore or bed sore. These areas include the spine, coccyx or tailbone, hips, heels, and elbows, to name a few.
The weight of the person’s body presses on the bone, the bone presses on the tissue and skin that cover it, and the tissue is trapped between the bone structure and bed or wheelchair surface. The tissue begins to decay from lack of blood circulation. This is the basic formation of how a decubitus ulcer, pressure sore and a bed sore are formed.
How Can Bed Sores Be Prevented?
Prevention consists of changing position every 2 hours or more frequently if the needs of the individual call for more frequent turning schedule. This 2-hour time frame is a generally accepted standard of care time frame that the tissue can tolerate pressure without damage. Prevention also consists of protection and padding to prevent tissue abrasion, and maintaining hydration, nutrition and hygiene which are all very very important.
How Are Bed Sores Treated?
The treatment for a decubitus ulcer, pressure sore, and bed sore involves keeping the area clean and removing necrotic (dead) tissue, which can form a breeding ground for infection. There are many procedures and products available for this purpose. The use of antibiotics, when appropriate is also part of the treatment. Some deep wounds even require surgical removal or debridement of necrotic tissue. In some situations, amputation may be necessary.
The second portion of the treatment involves removing all pressure from the involved area(s) to prevent further damage to tissue and to promote healing. Frequent turning is mandatory to alleviate pressure on the wound and to promote healing. Along with cleaning, removal of dead tissue, and alleviating pressure, the individual must have increased nutrition to allow for proper healing of the wounds. Without all of these elements being in place, the wounds will not heal and, in fact, will quickly worsen causing severe pain and wrongful death.
What Can Be Done To Prevent Bed Sores?
The main kind of treatment for decubitus ulcers, pressure sores, and bed sores is prevention. Prevention is a must and should be stressed by the health care provider. To this end, there are any number of devices designed to protect and prevent the formation of decubitus ulcers, pressure sores, and bed sores. The decision of which device to use is based on the location and severity of the wound.
Most insurance policies will cover any needed device, material, or equipment necessary to prevent and treat decubitus ulcers, pressure sores and bed sores. Decubitus ulcers, pressure sores, and bed sores are found to be “Never Events” by Medicare which means health care facilities and providers may not be reimbursed for the medical costs attributable to them.
Prevention, which means watching, caring, and taking the type to make sure that decubitus ulcers, pressure sores and bed sores do not develop is the patient’s best care scenario.
Why Do Bed Sores Frequently Develop in Long-Term Care Facilities?
In long-term care facilities, the rate of decubitus ulcer, pressure sore, and bed sore development is higher for a variety of reasons.
Due to staffing shortages, lack of sufficient medical funding, most long-term care facilities are chronically understaffed. This results in patients not being turned, cleaned, (hygiene) and fed, (malnutrition and dehydration) as often as a patient should be. Minimal turning schedules should be no longer than every two hours (Q2), and possibly in shorter intervals depending on the medical needs of the patient.
Medicare deems that the formation of decubitus ulcers, pressure sores, and bed sores should be “A Non-Event.”
Massive weight loss, massive deep wounds over Stage II and chronic infections continue to be an unacceptable standard of care. Massive wounds are generally a strong indication of negligence / neglect in more than one area [hygiene, nutrition, infection control, positioning, dehydration etc.]. The development of decubitus ulcers is sufficient evidence of neglect. Generally the neglect is in more than one area, i.e., hygiene, nutrition, hydration, contractures.
What Are the Wound Stages of Bed Sores?
Wounds are often categorized according to severity by the use of stages.
Stage I Decubitus Ulcers
This stage is characterized by a surface reddening of the skin. The skin is unbroken and the wound is superficial. This would be a light sunburn or a first-degree burn as well as a beginning Decubitus ulcer. The burn heals spontaneously or the Decubitus ulcer quickly fades when pressure is relieved on the area.
The key factors to consider in a Stage I wound is what was the cause of the wound and how to alleviate pressure on the area to prevent it from worsening. Improved nutritional status of the individual should also be considered early to prevent wound worsening. The presence of a Stage I wound is an indication or early warning of a problem and a signal to take preventive action.
Treatment consists of turning or alleviating pressure in some form or avoiding more exposure to the cause of the injury as well as covering, protecting, and cushioning the area. Soft protective pads and cushions are often used for this purpose. An increase in vitamin C, proteins, and fluids is recommended. Increased nutrition is part of prevention.
Stage II Decubitus Ulcers
This stage is characterized by a blister either broken or unbroken. A partial layer of the skin is now injured. Involvement is no longer superficial.
The goal of care is to cover, protect, and clean the area. Coverings designed to insulate and absorb as well as protect are used. There is a wide variety of items for this purpose.
Skin lotions or emollients are used to hydrate surrounding tissues and prevent the wound form worsening. Additional padding and protective substances to decrease the pressure on the area are important. Close attention to prevention, protection, nutrition, and hydration is important also. With quick attention, a stage II wound can heal very rapidly.
A wound can appear to be a Stage I wound upon initial evaluation, and actually be reevaluated as a Stage II wound during the course of care. Quick attention to a Stage I Decubitus ulcer or pressure wound will prevent the development of a Stage III Decubitus ulcer or pressure wound. Generally Decubitus ulcers or pressure wounds developing beyond Stage II is from lack of aggressive intervention when first noted as a Stage I.
Stage III Decubitus Ulcers
The wound extends through all of the layers of the skin. It is a primary site for a serious infection to occur.
The goals and treatments of alleviating pressure and covering and protecting the wound still apply as well as an increased emphasis on nutrition and hydration.
Medical care is necessary to promote healing and to treat and prevent infection. This type of wound will progress very rapidly if left unattended. Infection is of grave concern.
Stage IV Decubitus Ulcers
A Stage IV wound extends through the skin and involves underlying muscle, tendons and bone. The diameter of the wound is not as important as the depth. This is very serious and can produce a life threatening infection, especially if not aggressively treated. All of the goals of protecting, cleaning and alleviation of pressure on the area still apply. Nutrition and hydration is now critical. Without adequate nutrition, this wound will not heal.
Anyone with a Stage IV wound requires medical care by someone skilled in wound care. Surgical removal of the necrotic or decayed tissue is often used on wounds of larger diameter. A skilled wound care physician, physical therapist or nurse can sometimes successfully treat a smaller diameter wound without the necessity of surgery. Surgery is the usual course of treatment. Amputation may be necessary is some situations. Gangrene could also set in.
Stage V Decubitus Ulcers
This is an older classification and not now used in all areas. A stage 5 wound is a wound that is extremely deep, having gone through the muscle layers and now involves underlying organs and bone. It is difficult to heal. Surgical removal of the necrotic or decayed tissue is the usual treatment. Amputation may be necessary is some situations.
With multiple offices throughout California, The Peck Law Group’s bed sore attorneys can you assist you with your case, whether you are in Los Angeles or other areas including (but not limited to):