To aid in the prevention of Bed sores, Decubitus ulcers, and Pressure ulcers: elevation of the head of the bed to no more than 30 degrees (or at the lowest degree of elevation consistent with the patient’s medical condition); use of a 30-degree lateral lying position; avoidance of placement of the patient directly on his/her trochanter; use of lift sheets/equipment to reposition or transfer patients rather than dragging or pulling; employment of trapeze bars to facilitate the patient who is able to assist with mobility; protection of high-risk areas such as the elbows, heels and sacrum; and use of pillows or wedges to reduce pressure over bony prominences and to keep them from rubbing together. There is further agreement that donut-type devices should not be used for pressure redistribution; WOCN also recommends against foam rings, foam cut-outs, and synthetic sheepskin.
Support surfaces should be used on beds and chairs to redistribute pressure. HIGN cites static air, alternating air, gel, and water mattresses as options. WOCN notes that there is insufficient evidence to support the choice of one specific pressure redistribution surface/device over another, adding, however, that it has been reported that at-risk patients should not be placed on an ordinary, standard hospital mattress. WOCN continues to note that compared with standard hospital mattresses, alternating or dynamic mattresses and oscillating air-flotation beds have been associated with a lower incidence of pressure ulcers. They add that high specification foam has been shown to be effective in decreasing the incidence of pressure ulcers in high-risk patients. When choosing a support surface, WOCN states that factors to consider other than interface pressure include skin surface tension, shear force, temperature, humidity, the magnitude and duration of interface pressure, pressure and blood flow distribution, and adult versus pediatric patients.
With regard to heel pressure ulcers, that heel protection devices should completely offload (float) the heel. WOCN notes that no specific support surface or heel product has proven superior overall in decreasing pressure at the heel. They recommend against the use of synthetic sheepskin, bunny boots, rigid splints, IV bags, and rolled towels or sheets. WOCN adds that pillows under calves decrease heel interface pressures as well as foam cushions under calves, and that the recommended method is to place the pillow longitudinally underneath the calf with the heel suspended in air.
Chair-bound individuals have unique repositioning and pressure redistribution needs. There is agreement that for those who can reposition themselves while sitting, pressure relief using weight shifts or activities (e.g., chair push-ups, standing and re-sitting, elevating the legs or placing the feet on a stool) should be encouraged every 15 minutes. There is further agreement that those who are incapable of performing position changes while sitting should be repositioned at least every hour by a caregiver. The use of a pressure-reducing device (not a donut) is recommended by both groups for chair-bound clients. According to WOCN, selection of appropriate pressure redistributing chair cushions should be done by trained health care professionals who have specific knowledge and expertise in this area; chair cushions have not been adequately evaluated to recommend one over another.
The PECK LAW GROUP specializes in Personal Injury matters relating to Serious and Catastrophic Injury, Nursing Home Abuse and Neglect, Bed Sores, Decubitus Ulcers, and Pressure Sores, Medical Malpractice, Surgery Errors, Traumatic Brain Injury, Birth Injury and Wrongful Death that are determined to be a breach of the standard of care. Our experts and our attorneys have superior knowledge and know how in handling these type of matters from inception to Trial if need be. You will receive superior representation and of course the best possible result based upon our know how and expertise.
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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.