Ways to Help Prevent Decubitus Ulcers

Positioning in bed

1. Avoid positioning patient on ulcer
2. Use positioning device to keep ulcer off surface
3. Avoid donut-type devices (may cause ulcers)
4. Written repositioning schedules every 2 hours

Prevention for patients at risk

1. Avoid positioning immobile patients on trochanters
2. Use pillows and foam wedges
1. Relieve heel pressure
2. Relieve bony prominence pressure (knee and ankle)
3. Sheepskin does not relieve pressure
3. Maintain head of bed at lowest appropriate level
1. Limit time head of bed is elevated
2. Higher head of bed causes patient to slide down
1. Sliding leads to shear forces
2. Sacral ulcers may result

Management: Bed Types

1. Static Surfaces
1. Surface types
1. Mattress
2. Foam
3. Static floatation
2. Indications
1. Patient in many positions without loading ulcer
2. No bottoming out of patient
3. Fully compresses surface to <1" at injury site
2. Dynamic Surfaces
1. Surface types
1. Air-fluid (costs $100 per day)
2. Low-air (costs $65 per day)
3. Alternate air
2. Indications for all dynamic surfaces
1. Stage 3 or 4 Decubitus Ulcers
2. Conditions not met for static surface bed
3. Pressure Ulcer not healing by 2 to 4 weeks
3. Additional indications for air-fluid or low-air bed
1. Large Stage 3 to 4 Ulcers
2. Ulcers on multiple turning surfaces
3. Ulcer fails to heal on dynamic overlay

Management: Tissue loads while sitting

1. Avoid pressure on ulcer while sitting
2. Properly position
1. Consider patient weight
2. Consider balance
3. Consider patient stability
3. Reposition so pressure points shifted once per hour
1. Return to bed if this schedule can not be met
2. Attempt to teach patient to shift weight every 15 min
4. Appropriate seat cushion (avoid donut-types)

Decubitus ulcer definition:

Ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time; bony prominences of the body are the most frequently affected sites; ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure.

An ulceration caused by prolonged pressure on the SKIN and TISSUES when one stay in one position for a long period of time, such as lying in bed. The bony areas of the body are the most frequently affected sites which become ischemic (ISCHEMIA) under sustained and constant pressure.

Common Names for decubitus ulcers:

Bed sore, Bed Sores, Bedsore, Bedsores, Contact ulcer, Decubitus, Decubitus pressure sore, DECUBITUS SKIN ULCER, Decubitus ulcer, Decubitus ulcer any site, Decubitus Ulcers, Pressure Sore, Pressure Sore Or Ulcer, pressure sores, Pressure Sores/Ulcers, Pressure Ulcer, Pressure Ulcers.

– from Steven Peck, Senior Attorney at Peck Law Group
 

About the Author

Attorney Steven Peck has been practicing law since 1981. A former successful business owner, Mr. Peck initially focused his legal career on business law. Within the first three years, after some colleagues and friend’s parents endured nursing home neglect and elder abuse, he continued his education to begin practicing elder law and nursing home abuse law.