How Common Are They and How Do They Start?
Pressure ulcers, also known as pressure sores, are one of the most common side effects of long-term care around the world, affecting about 8.4 percent of hospital patients specifically. In the United States, around 2.5 million people get pressure ulcers every year. According to that math, at any given time, one in every 13 long-term care patients is suffering from a pressure ulcer.
They rarely form except when a negligent caregiver fails to provide adequate daily care and treatment to a patient who cannot help themselves.
According to the American Family Physician Journal, “Pressure ulcers are caused by unrelieved pressure, applied with great force over a short period (or with less force over a longer period), that disrupts blood supply to the capillary network, impeding blood flow and depriving tissues of oxygen and nutrients.”
This commonly occurs when patients must lie in a bed for a long period of time without moving or when an injury prevents them from moving. There are four stages of a pressure ulcer, ranging from reddening of the skin to a deep open wound resulting in exposed injury to the muscle and bone. Pressure ulcers can be extremely painful and result in serious medical complications, including death, for many hospitalized adults.
In this article, we will explain how pressure ulcers are caused, some of the first signs of pressure ulcers, why they are so common, and how to avoid them.
What Is the First Sign of a Pressure Ulcer?
The first sign of a pressure ulcer is redness and soreness of the skin. This often occurs on the heels, hips, tailbone or other bony body areas. At this stage, stage 1, symptoms will likely be limited to area soreness and irritation.
Following this first stage, the skin will develop the shallow opening that most commonly resembles an ulcer. At stage 2, the skin will appear very raw and painful to the touch.
The third stage of a pressure ulcer results in a full loss of tissue and the revealing of subcutaneous fat. The pain steadily worsens and infection becomes increasingly more likely.
The fourth stage is the most damaging, as a stage 4 pressure ulcer will expose muscle, tendon and bone to pathogens.
While these stages are all very painful for hospital patients, deeper problems usually result following the development of pressure sores and proper treatment with good daily skin care can prevent them. They are the most difficult to diagnose in patients who are bedridden due to the severity of their underlying medical condition and unresponsive. If they cannot recognize and/or communicate their pain, they require regular skin examinations every nursing shift to detect and prevent pressure sores.
How Can Pressure Sores be Avoided?
Yes. Proper, regular and competent attention by caregivers will prevent nearly all pressure sores.
Sudden weight loss and nutritional compromise often causes pressure sores. If a patient is ill and stops eating properly, they are likely to lose a significant amount of weight all at once. If they are also immobile at this time, the loss of fat and inability to shift positions can quickly lead to pressure sores.
Even if a patient is not losing weight, the inability to move their body from one position to another or get out of bed briefly to walk around the room could result in the development of pressure sores.
In hospitals, healthcare professionals like nurses and certified nursing assistants are required to evaluate patients regularly to assess their medical condition and determine their risk for a pressure ulcer.
Most use the Braden Scale, which evaluates patients based on their:
- Mobility
- Moisture levels in areas where pressure ulcers commonly occur
- Activity
- Ability to respond to stimuli and relate pain or discomfort
- Nutrition and amount of protein ingested in a day
- Friction and shear caused by the inability to keep from sliding in sheets, chairs, etc.
If patients are immobile, inactive and nutritionally compromised, they are at much higher risk of developing a pressure sore. To avoid these sores, healthcare workers should regularly determine patients’ risks of developing a pressure sore and help them as appropriate. Regularly turning and positioning immobile or bedridden patients, ensuring proper nutrition and adequate protein intake and keeping patients’ skin clean and dry are all steps healthcare workers should take to prevent hospital acquired pressure sores.
Are There Long-Term Consequences From Pressure Sores?
Because pressure sores affect the integrity of your skin, they may cause long-term effects, including death, if improperly treated. Proper care and treatment of these avoidable injuries can take six months or more to see measurable results and if not carried out appropriately can lead to more severe problems.
Some common pressure sore complications include:
- Infections. Infections to bones and joints are common due to spreading infection from the exposed skin on an ulcer. Infections in joints, also called septic arthritis, damages cartilage tissue. Infections in bones, also called osteomyelitis, can cause seriously reduced function in joints and limbs.
- Sepsis. Sometimes, an ulcer on the skin can become septic. Sepsis occurs when your body violently reacts to an infection and begins attacking and shutting down vital organs and other important functions.
- Cellulitis. Cellulitis is an infection of skin and tissue that usually leads to warmth, redness and swelling. Many people who suffer pressure sores may also have nerve damage and cannot feel the pain and damage from cellulitis.
- Death. If a pressure sore injury is not timely and properly treated, resulting complications can cause or contribute to a patient’s death.
Whether or not a pressure sore results in any complications, these sores are still a very painful, serious and easily avoided medical issue.
Why Are Pressure Ulcers so Common?
Pressure ulcers are common not just in hospital patients, but also in nursing homes and assisted living facilities. There are various reasons for their commonality, ranging from staffing issues in hospitals and long-term care health facilities to the seriousness of a patient’s medical condition.
If seriously ill patients are unable to properly sit up in bed, reposition themselves or move around, they are much more likely to develop pressure ulcers. In addition, unresponsive patients can be difficult to manage if they are unable to indicate where they have pain or request that they would like to move. The inability to walk or support oneself can increase the risk of developing a pressure ulcer.
In these types of cases, nurses and staff members should help their high-risk patients move as much as necessary. They should focus their efforts on providing good daily skin care treatment, keeping patients clean and dry (in areas where pressure sores commonly develop, and in areas where sweat and urine can cause high moisture levels) and turning and positioning their patients on a regular hourly schedule. In some cases, this may mean only turning a patient from one side to another, but even this exercise can significantly improve patients’ chances of avoiding pressure sores.
There are two main reasons that hospital nurses and staff members do not provide proper daily skin care to prevent pressure ulcers:
- Lack of education
- Understaffing
In many cases, hospitals, nursing homes and many long-term health care facilities simply do not properly educate their medical staff members about pressure ulcers. Nurses and caregivers may disregard that daily responsibility believing other things are more pressing and imminent. They may be unaware of the various factors that increase their patients’ risk for developing pressure sores.
In addition, management may intentionally understaff a healthcare facility to save money. Having too few caregivers to provide adequate daily skin care and treatment can increase the incidents of pressure sores. Further, given that pressure sores are less well known and may be seen as less significant than other health issues, available staff members may not have the time or concern to take the proper steps to prevent them.
Thus, the most important steps for healthcare facilities to take to prevent pressure ulcers would be to increase staff awareness and provide more workers in a daily rotation, each shift.
Pressure Sore Lawsuits and Claims
According to Federal Law:
“The facility [hospital, nursing home, long-term care facility] must ensure that –
(i) A resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual’s clinical condition demonstrates that they were unavoidable; and
(ii) A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing.”
If a healthcare facility fails to follow the law to prevent pressure ulcers, it may be possible to bring a lawsuit against an offending hospital. The hospital must properly care for and treat any patients admitted to their beds. If they fail to do so, they can be sued and forced to compensate injured victims and their families. Generally, this would prompt a medical malpractice claim which is a legal action in which “a hospital, doctor or other health care professional, through a negligent act or omission, causes an injury to a patient.”
There are three basic requirements for a medical malpractice claim:
- The practitioner and/or hospital must have violated a standard of care.
- The negligence of the practitioner and/or hospital must have caused an injury.
- The injury resulted in loss or damage.
If you can prove that you have suffered loss, injury or damage due to the negligent acts or omissions of a healthcare provider, you may sue the hospital or medical facility for compensation for the damages suffered.
What to Do if You or a Loved One Has a Bedsore
If you or a loved one develops a bedsore, there are a few things you should do immediately. First, notify your treating physician, your health care providers and caregivers and the nurse supervisor of the presence of the pressure ulcer and request a full assessment and proper treatment. Treatment should include the regularly turning and positioning of the patient at least every 2 hours to shift the body weight off the affected area, cleaning the area and keeping it dry to avoid exposure to germs and bacteria, monitoring the patient’s protein and fluid intake to ensure proper nutrition and reducing friction as much as possible.
Pressure ulcers can take six months or more to heal, depending on their severity and the effectiveness of the treatment received. Wound care treatment for bedsores can be very expensive and extremely time-consuming for any family member directly involved with the patient’s care. As discussed above, you may sue for medical malpractice to recover damages for any medical expenses and wage loss associated with the pressure sore.
The difficulty of living with a pressure sore and dealing with the painful consequences of an open wound which requires daily care and painful treatment can have a significant impact on your quality of life. So what should you do if you developed a pressure sore in a hospital? If you are unsure of your legal options, you may want to contact a medical malpractice attorney.
Any injury, even if not a result of negligence, comes with serious consequences. However, when an avoidable injury, such as a pressure ulcer, is a result of poor care and treatment by health care providers who were negligent, it may hurt far more. You and your loved ones should not be forced to suffer through all the pain, mental anguish, inconvenience and needless expense without help. Instead, your caregivers should be held accountable for the pain and suffering caused by their careless medical negligence.
Medical malpractice attorneys know how to deal with hospital corporations, medical professionals, insurance companies and their very skilled defense lawyers. They can evaluate your claim and determine if you have a case. An experienced medical malpractice lawyer can help you determine if you are entitled to monetary compensation for your treatment and determine the amount you justly deserve to recover in damages for your pressure ulcer injuries.
If you have more questions, a medical malpractice attorney can provide the guidance you need. Pressure ulcers are painful and unfortunately common these days in hospital patients. However, if treated appropriately and early they should not deteriorate and lead to serious illness, excessive suffering and death. Get the help you need to deal with the pressure ulcer so that you can move on and live your life in peace. If you or a loved one suffers from pressure ulcers due to negligence or malpractice in a healthcare facility, it is important you hold those caregivers responsible.