In the United States, the prevalence of decubitus ulcers, also known as pressure ulcers, is at a high of around 8 percent. These ulcers lead to thousands of deaths each year. Most of these deaths occurred in those over the age of 80 and resulted from the pressure ulcer causing a significant blood infection such as sepsis (also known as septicemia).
Pressure ulcers are a growing problem in healthcare and medical malpractice cases. Those suffering from decubitus ulcers are likely suffering the effects of healthcare neglect, due to understaffing or lack of education for medical professionals. If healthcare workers knew about and effectively prevented and treated pressure ulcers, they could avoid many avoidable pressure ulcer injuries and deaths.
In this article, we will explain what pressure ulcers are, how they arise, how to treat them, and what to do if you or a loved one has suffered from a pressure ulcer and its lasting effects.
What Is a Pressure/Decubitus Ulcer?
A pressure ulcer, also called a decubitus ulcer or a bedsore, is caused by the wearing away of the skin due to pressure from prolonged contact with a bed or other surface and little movement. These ulcers often show up on skin where there is some prominence of the bone, such as the hips, tailbone, or heels.
There are four stages to a pressure ulcer, varying from discoloration and soreness to severe loss of skin and tissue:
- Stage I. In Stage I, a pressure ulcer manifests as a redness on the skin. At this point, the skin is still intact but might be sore and tender. This stage is the easiest to treat if it is dealt with quickly.
- Stage II. Stage II ulcers will manifest skin erosion and partial loss of the dermis and/or epidermis so that there is a break in the skin. In general, the skin probably looks a bit white, like a blister. This stage is harder to treat because the skin is already broken, but medical professionals should protect it with a bandage and cleanse it regularly.
- Stage III. Stage III ulcers extend to the fat tissue below the skin but do not extend into the muscle, tendon or bone. Treatment increases in difficulty since the skin is gone, exposing the inner body to the pathogens.
- Stage IV. By the time a pressure sore has reached Stage IV, cells have died and the muscles, tendons and bones may be exposed. This is where decubitus ulcers become especially dangerous because of exposure to bacteria. It is often in the last two stages that infection arises in patients, sometimes leading to death.
- Unstageable. In some cases, scabs, black, dead tissue may cover a sore, making it unstageable. In this case, medical professionals must remove the material (often through a painful surgical treatment called debridement where the dead tissue is actually cut away with a scalpel until viable tissue is revealed) before diagnosing the stage. Generally, these wounds are in the later stages — most commonly considered Stage IV.
How Do Decubitus Ulcers Arise?
Decubitus Ulcers are called bedsores for a good reason. Most often, these sores arise in older patients and/or those who are confined to their beds for a long time. The constant pressure of skin against a surface (even if that surface is something soft, like a sheet), begins to wear it down.
This can be complicated further by:
- Friction on the skin
- Shear, often caused when the body slides down in bed but part of the skin doesn’t slide and suffers further pressure
- Moisture, often cause in patients with bowel and bladder issues, which leads to the weakening of the skin and increased risk for wear
- Incontinence, which increases both moisture and bacteria in the area
Pressure ulcers are most common in elderly patients who are unable to move or turn and reposition themselves regularly. Risk factors heighten if the patient cannot communicate or feel any soreness or discomfort to healthcare professionals or caregivers, who then leave the patient in one position for too long. Nerve damage or the constant use of pain medication can also heighten risk by weakening patients’ pain receptors.
The elderly have fragile thinning skin, weakened ability to move or turn and reposition on their own (even during sleep), and in some cases, serious health conditions that lessen their pain or understanding of bedsores. According to recent CDC data, around 11 percent of all nursing home residents suffered from a pressure sore.
Another factor in the prevalence of pressure ulcers is malnutrition. If a patient has lost a significant amount of weight from a lack of protein to sustain body strength or the loss of fat and cushioning, the likelihood of a pressure ulcer rises significantly. If bones begin to protrude more than usual due to weight loss, they are more susceptible to developing pressure sores.
Complications of Decubitus Ulcers
Decubitus ulcers can lead to much more serious health problems if they are not properly taken care of quickly and appropriately. According to Johns Hopkins, the mortality rate has been known to be as high as 60 percent for patients who developed pressure sores within a year after they were discharged.
Some of the most common complications for pressures sores include:
- Sepsis, an infection of the blood that leads the body to attack organs and often leads to death
- Localized infection, which can easily lead to spread within the body
- Cellulitis, a skin infection that can spread to lymph nodes and blood and cause serious swelling, and in some cases can lead to death
- Osteomyelitis, an infection in the bones that can kill bones and lead to a severe weakening of the body
- Depression and pain, which are often associated with a chronic medical issues and a constant lack of healing in the body
While appropriate treatment can prevent these complications, providers and caregivers often fail to provide it. Those in charge of watching over immobile or elderly patients must prevent pressure ulcers.
How to Prevent Decubitus Ulcers
The National Pressure Injury Advisory Panel, in association with the European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, developed a guide to help caregivers and healthcare providers identify and prevent pressure ulcers in their patients. The guide is quite long, but there are several main factors that one should look at when identifying risk factors for pressure ulcers.
- The mobility of patients and their ability to move and turn and position themselves, if necessary
- The existence of one early or late-stage pressure injury and the likelihood of more developing
- Any alterations in skin status, especially around pressure points where the bone is prominent
- The impact of pain on pressure injuries, such as whether a patient will feel it or not
- How perfusion (blood delivery) and circulation deficits might increase the likelihood of a pressure injury
- Consider oxygen deficits
- Consider nutritional deficits
- Consider older age
- How often the skin is moist
- The general health status of the patient
- The length of health stay
After making these considerations, healthcare providers must prevent pressure sores from arising.
They need to:
- Cleanse the skin regularly
- Protect skin from moisture
- Avoid vigorous rubbing
- Use low-friction bedding to protect skin
- Increase calorie and protein intake for at-risk patients
- Provide nutritional supplements for patients who can’t eat solid food
- Keep patients hydrated
- Turn and reposition patients regularly to avoid areas that are prone to bedsores
- Turn and reposition patients as much as possible without causing unnecessary friction
- Keep the head of the bed lowered and flat
- Tilt wheelchairs to keep patients from sliding forward
- Elevate heels to avoid the development of a pressure sore
- Pay attention to equipment and bed type to adjust for patients’ comfort and ability to move around
- Provide appropriately sized medical instruments and check regularly to ensure they don’t cause soreness
These are the basic ways to avoid pressure injuries of any kind. However, many healthcare providers, caretakers, and nurses do not properly monitor their patients to prevent decubitus ulcers.
In addition, understaffing often besets healthcare facilities. Employers like large hospital chains and nursing homes do not always provide enough nursing staff within their facilities to give caregivers the time to appropriately watch and care for patients who might be at risk for develop a pressure ulcer.
Healthcare providers must know the dangers of pressure ulcers and prevent them. They must provide proper care for patients in their hospitals and facilities. Failure to follow through on that duty might constitute medical malpractice, defined as occurring when “a hospital, doctor or other health care professional, through a negligent act or omission, causes an injury to a patient. The negligence might be the result of errors in diagnosis, treatment, aftercare or health management.”
If you know of a patient who develops a pressure ulcer while under the care of a nurse, medical practitioner or health care provider, you should let someone know. These caregivers should be held accountable for a failure to perform their daily duty in caring for and treating their patients.
How to Treat Decubitus Ulcers
Decubitus ulcers can respond to treatment. While the healing process often takes a long time, even up to six months or more, it is still possible that treatments will work if applied quickly and properly.
Some of the most common treatments include:
- Reducing pressure on the area by turning and repositioning the patient regularly — at least every 2 hours
- Providing extra support from pillows, etc. to keep the affected area free
- Cleansing the wound regularly with appropriate solutions and applying bandages such as gauze, film, gel, foam, etc.
- Improving diet to promote healing
- Removing damaged tissue in more serious cases
- Performing debridement surgery when wounds appear necrotic, or black of if a wound refuses to heal
These treatments may include the help of doctors, nurses, wound care specialists, and other therapists who can help the patient recover the use of their body as effectively as possible.
What to Do if You or a Loved One Has a Decubitus Ulcer
The first thing to do if you find out that you or someone you love has developed a bedsore is to demand immediate treatment. Skincare specialists and wound specialists may help you in this situation. Do everything you can to increase nutrition intake and repositioning practices of the nurses and health care staff responsible for the patients diet and daily skin care.
If the pressure sore appears in the hospital, nursing home or assisted living facility, you may want to seek legal help in addition to medical treatment. In most cases, pressure sores are easy to prevent if nurses or other health care providers take the time necessary to assess the patient’s risk and provide proper preventive measures. If they failed to do so, these medical providers may be liable to pay for the pain, suffering and bodily injury they have caused.
Medical malpractice cases are actually quite common. In fact, over 200,000 people die from medical malpractice incidents every year in the United States. These cases often have very high returns due to the extensive medical treatment costs and the severe consequences of inappropriate treatment.
If you suspect you may have a medical malpractice case against those who neglected to prevent and/or treat a pressure ulcer, there are a few things you can do. First, please make sure you photograph the pressure sore regularly. Healthcare professionals may not want to do this, as it could reveal the seriousness of the injury and lead to legal action. As a patient, a spouse, child or family member, you have a legal right to photograph and document any pressure sore injuries.
Second, make sure that you or your loved one is turned and repositioned, at least, every two hours to reduce the injury’s severity. If you have more questions about a pressure sore injury and your legal rights, a medical malpractice lawyer experienced in pressure ulcer cases is an excellent resource. You deserve fair, competent medical treatment, and you should not be forced to suffer pain and avoidable injury due to another’s negligence. Contact The Fernandez Firm for a free case evaluation today.