Pressure sores, also known as pressure ulcers or bedsores, occur from prolonged pressure on a specific area of the body. Usually, this pressure occurs because negligent caregivers did not help a patient who cannot easily move around and is confined to a bed or wheelchair.
Pressure sores can develop in hours and can lead to serious complications if not treated immediately. Healthcare professionals need to regularly assess a patient’s risk of pressure sores and monitor high-risk patients appropriately. If pressure sores appear, prompt treatment can improve the patient’s overall prognosis and decrease the risk of complications.
How Often Should Nursing Staff Conduct Pressure Sore Risk Assessments?
In the past, experts recommended that nursing staff conduct pressure sore risk assessments every 48 hours to determine whether the patient had signs of a pressure injury. More recent literature, however, suggests that hospitalized patients should receive a full risk assessment every 24 hours.
In general, 80 percent of patients who develop pressure sores do so within the first two weeks of hospitalization, and around 96 percent of pressure sores develop within three weeks. During these critical weeks, nursing staff should exercise extra care when checking on patients so they do not develop pressure sores or serious complications.
The Importance of Immediate Treatment
Immediate treatment for pressure sores can reduce a patient’s risk of serious injuries. Doctors grade pressure sores according to four levels of severity.
At Stage 1, pressure sores have not yet broken the skin. Nursing staff can usually spot them due to minor redness or patient discomfort. As pressure ulcers progress to Stage 2, they usually involve a minor break in the skin that may produce some pus and drainage.
By Stage 3, the pressure sore will show signs of deepening infection, moving further into the skin and showing increased redness. Sometimes, nursing staff can see the fatty layer below the skin through the pressure sore. By Stage 4, the pressure sore may involve muscle tissue and can result in severe, sometimes long-term complications.
Pressure sores should never develop in a patient, and if they do, an alert, competent staff should prevent all of them from proceeding to subsequent stages. Prompt identification and treatment of pressure sores can help prevent them from developing into more serious problems.
After identifying a pressure sore, nursing staff members can take five key steps:
1. The patient can move to a position that does not put pressure on the affected area.
Often, a simple move in position can prevent bedsores or resolve any issues that caused pressure sore in the first place, allowing the patient to shift pressure and weight to another area of the body. Sometimes, nursing staff may use a positioning device to keep weight off of the affected area or make the patient more comfortable. The patient may need to keep pressure off the sore until it has a chance to fully heal.
If the patient does not move off of the affected area of the body, on the other hand, the pressure may cause the sore to continue to worsen. Patients may complain of pain that increases in severity, or in some cases, struggle to change position on their own, despite a lack of mobility or the ability to move safely. Some patients, especially those with nerve damage, may not realize that they have developed a pressure sore until it increases substantially in severity.
2. Nursing staff members can start treatment to reduce the risk of infection.
Once nursing staff members identify a pressure sore, they should carefully clean the area. The cleaning process can help remove foreign bacteria, which could cause substantial infection if allowed to enter the body.
3. Covering the wound with a dressing can help decrease both pressure and infection.
Nursing staff members may use several dressing methods, from bandages to a barrier cream, to prevent infection and aid in healing. Keeping the skin clean, dry, and protected will help the wound heal much faster.
4. Once nursing staff members have identified a pressure sore, they can track the progress of the patient’s recovery.
Once you develop a pressure sore, staff need to keep a close eye on it to make sure that it heals appropriately. Unfortunately, some patients, especially those that remain bedbound, may never fully heal. By keeping an eye on those pressure sores, nursing staff members can check the healing progress and report to a doctor if healing does not progress as it should.
5. After identifying a pressure sore, nursing staff can help a patient adjust nutrition and hydration as needed.
Adequate nutrition and hydration can have a huge impact on a patient’s overall ability to heal, especially when it comes to pressure sores. Inadequate nutrition not only increases the risk that a patient will develop serious complications while healing, especially skin problems or pressure sores, but it can also prevent the patient from healing properly. Once nursing staff members identify a problem, however, they can often work with a patient to adjust food and water intake as needed, which can lead to a healthier patient and lower the risk that the patient will develop pressure sores again.
Risk Factors for Pressure Sores
Pressure sores occur frequently in patients who, for whatever reason, have a significant loss of mobility. Pressure sores can develop in elderly patients who cannot get out of bed on their own, patients who must stay in bed following severe illness or injury, or patients who cannot comfortably move around in bed while recovering or due to their injuries. Patients with nerve damage, including those with spinal cord injuries, may have a higher risk of developing severe pressure sores because they do not feel the discomfort associated with the pressure injury.
Patients who must use a wheelchair to get around the majority of the time may also have a high risk of pressure sores. To reduce this risk, patients should talk to their doctors about getting the wheelchair fitted properly, which will increase the odds that they will remain comfortable as they go about their daily lives.
Other factors that can increase the risk of developing pressure sores include:
- Skin condition. Existing skin conditions, including rashes, wounds, and lesions, may lead to more tender skin that may, in turn, result in a higher risk of developing pressure sores. Patients with existing skin conditions may need more observation and care to help reduce the risk of developing severe pressure sores.
- Diabetes. Diabetes can have substantially increase a patient’s risk of developing severe bedsores. Patients with diabetes often face slower healing than other patients, which can further worsen pressure ulcer symptoms. Medical charts need call attention to diabetes and staff needs to properly implement a treatment plan designed to prevent the risks it brings.
- Vascular problems. Patients with heart problems or circulatory concerns may not have adequate blood flow through the body, which can increase both the risk of developing pressure sores and the time needed to heal following the development of a pressure sore.
- Incontinence. Extended exposure to urine and/or feces can cause the skin to break down, making it more sensitive to pressure sores and other challenges. While nursing staff may do their best to change bedding and clean their patients after bathroom use, overworked staff may fail to keep up with that workload, which can increase the risk that patients will develop pressure sores.
- Nerve damage. Patients with nerve damage may have a higher risk of pressure sores because they do not feel the increasing pressure or pain. Consequently, they may not naturally move as often as they would if they had full sensation, or may remain on a sensitive area of the body even after a pressure sore begins to develop. Staff, then, needs to take responsibility to reposition these patients regularly.
- Poor nutrition and hydration. After a serious illness, some patients struggle to take in adequate food and water. They may lose their appetite, struggle with a loss of taste, or simply not like moving around in bed to eat. Elderly patients also often struggle with adequate nutrition and hydration, especially if they develop Alzheimer’s or dementia. Inadequate nutrition and hydration, however, can decrease the skin’s natural elasticity and sap the patient’s ability to heal. These patients may have a higher risk of developing pressure sores, so staff need to take special care with them. When they do develop pressure sores, patients may also take longer to heal.
What Happens if Nursing Staff or Caregivers Do Not Check for Pressure Sores?
If nursing staff or caregivers for patients with little mobility fail to conduct proper pressure sore checks, they can substantially increase the odds that the patient will develop an unchecked pressure sore, which may quickly progress to Stage 2, 3, or 4. At those stages, patients may face longer healing times and more serious complications.
If you notice a pressure sore on yourself or a family member under the care of skilled nursing staff, follow these key steps to protect the patient.
- Photograph the pressure sore or sores. Collecting photos of your injuries can serve two key purposes. First, photos show what the pressure sore looked like when you discovered it, which can make it easier for you to judge the progress of its healing in the future. Second, photographing the pressure sore will provide evidence of the patient’s lack of care later. Make sure that you have good lighting. You may want to include a size reference so that you can more easily track the progress of the sore’s healing.
- Notify nursing staff immediately. Notifying nursing staff can call the problem to their attention and increase the odds that they will take care of the patient’s needs in the future. Letting the nursing staff know that you identified a problem will also allow the patient to receive immediate treatment, which may protect against future complications.
- Watch (and document) the healing of the pressure sore. Keep track of the healing process and make sure that the pressure sore heals appropriately. Take photos of the pressure sore along the way, so that you can compare the photos, keep track of how the injury has healed, and provide evidence if needed later. If you notice the pressure sore getting worse rather than improving, report it to the doctor as soon as possible.
Get in touch with an experienced pressure sore attorney. If you discover a pressure sore or see complications in the healing process, get in touch with an experienced pressure sore attorney as soon as possible. An attorney can help you understand your rights, from your right to move yourself or a loved one to another facility after receiving inadequate care to your right to compensation following gross negligence in a medical care or nursing home setting.
If you or a loved one developed a pressure sore from negligence on the part of a nursing home or skilled nursing facility staff or suffered a pressure sore while in the hospital due to inadequate care, you can pursue compensation for the full cost of your injuries. A free consultation with an experienced attorney can help you better understand your rights and determine the next stages in your claim.