Bedsores, also known as decubitus ulcers or pressure ulcers, should rarely occur. They are preventable. A bedsore is caused by lying on a bony area for long periods of time without turning and repositioning , causing a decrease in blood flow to that part of the skin, which in turn, causes the skin to break down. If a resident or patient develops a bedsore, it is usually because the nursing home or hospital failed to provide proper care. Proper care includes:
Turning and repositioning the patient every 2 hours. This is the industry standard. Turning and repositioning is especially important if the resident is bedridden and/or unable to turn and reposition herself. If so, the staff is supposed to turn and reposition the resident every 2 hours. The staff’s failure to do so can cause a resident to develop one or more serious bedsores. A bedsore can develop anywhere on the body, but they often occur on the tailbone, buttocks and heels. Tip: Whenever you are visiting with your loved one, see if anyone comes into the room to turn and reposition him.
Keeping the patient’s skin clean and dry. If the staff fails to keep the patient’s skin clean and dry, the skin will start to break down. This is especially true for incontinent patients and patients who need assistance getting to the bathroom. When a patient is forced to lay in his own feces or urine, his skin begins to break down and a bedsore will develop—and it can happen quickly. Tip: If an incontinent patient (or a continent patient who needs assistance to the bathroom) develops a bedsore on her buttocks or tailbone, that is often an indication that the staff failed to provide timely incontinence care (or bathroom assistance) to the patient.
Applying barrier creams. The staff’s application of a barrier cream to the resident’s skin helps keep the skin protected and dry and reduces the risk of skin breakdown.
Monitoring the patient’s skin for breakdown. This seems obvious, but many times the nursing home or hospital is understaffed and as a result there is not enough staff to monitor each resident’s skin on a regular basis. Bedsores can then develop and go unnoticed by the staff. Tip: If the bedsore, when first discovered, is large and/or deep, or if it is discovered by the patient’s family rather than staff, that is often an indication that the staff was not monitoring the resident’s skin on a regular basis.
Developing and then implementing adequate care plan interventions addressing the patient’s risk for skin breakdown. Upon admission to a nursing home or hospital, a new patient/resident should be assessed by a nurse for risk of skin breakdown. This is called a Braden Assessment. Once admitted, those residents determined to be at risk should be assessed again at least quarterly, and more often (usually monthly) if the resident is at high risk. The care plan team then develops a number of strategies (“care plan interventions”) designed to reduce the resident’s risk for skin breakdown. When a resident nonetheless develops a bedsore, it is usually because the staff either failed to develop adequate interventions to address the resident’s risk for skin breakdown, or failed to consistently implement the interventions that were developed (usually because the facility is understaffed or the staff is not properly trained).
A bedsore is identified by its stage. The deeper the bedsore, the higher the stage and the more severe it is. A stage I bedsore is just an area of red skin. A stage II occurs when there is some loss of skin and a sore starts to form. A stage III occurs when there is further loss of skin and the sore is deeper, often down to the muscle. A stage IV occurs when the sore is even deeper, often down to the bone.
Bedsores are very painful, and they can become infected especially when the nursing home or hospital fails to follow proper infection control protocol. A stage III or IV bedsore can take a long time to heal; it is a very difficult and painful process. Oftentimes, the bedsore grows progressively worse. It can develop gangrene and can even result in the amputation of a limb. Bedsores can also contribute to or cause death, especially among the elderly.