Medical patients who have limited mobility, and especially those who are residents in nursing homes, are at risk for skin breakdown. When skin breakdown occurs, it can lead to a condition known as a decubitus ulcer, also known as a pressure sore, pressure ulcer, or bedsore.
State and federal law requires that patient care facilities and nursing homes take a proactive approach to identifying patients who are at risk for developing pressure ulcers and take steps to prevent and heal bedsores. When pressure ulcers occur or get worse, the medical provider or nursing home can be held legally responsible. Unfortunately, too many hospitals and nursing homes do not have adequate staff to prevent pressure ulcers from developing and, in an attempt to avoid responsibility, claim that the bedsores were unavoidable.
What Are Bedsores?
Bedsores - also known as decubitus ulcers, pressure sores, or pressure ulcers - are injuries to the skin and underlying tissue that are caused by prolonged pressure on the skin. They are particularly common in older patients whose skin is not as resilient as it was when they were younger, and in patients who have limited mobility and rely on nurses and other care providers to reposition them. People who lie in bed, are in a wheelchair, are unconscious, or wear a cast for a long time are at a higher risk for developing bedsores.
Bedsores commonly occur on bony areas of the body like the heels, ankles, hips, and tailbone.
How Are Pressure Ulcers Diagnosed?
Bedsores are graded on a scale from 1 to 4, with 1 being the least severe and 4 being the most severe. As the skin begins to die the tissue turns red or purple, and can eventually break open and become infected. Left untreated, a bedsore can penetrate deep into the muscle and bone. The severity of a bedsore is classified along the following scale:
Stage 1 Bedsore: The skin is red or purple and feels warm to the touch. The patient may complain that the skin feels itchy, burns, or hurts.
Stage 2 Bedsore: The area appears more damaged and may have a small open sore. The patient may complain of significant pain and the skin around the wound may be discolored.
Stage 3 Bedsore: The area has a crater-like appearance caused by damage to tissue below the skin.
Stage 4 Bedsore: The skin is severely damaged and a large wound is present. There may be damage to muscles, tendons, bones, and joints. There is a significant risk of infection.
What Are the Signs and Symptoms of Bedsores?
Changes in skin color or textureIf your loved one is in the hospital or a nursing home and has limited mobility, be on the lookout for common signs and symptoms of bedsores, including:
A foul odor
An area of skin that is red and feels cooler or warmer to the touch than other areas
Bedsores can be prevented by moving a patient regularly. Nursing homes are required to reposition bedridden patients every two hours to prevent bedsores.
How Are Decubitus Ulcers Caused?
Bedsores occur when there is pressure that limits blood flow to the skin. Blood delivers essential oxygen and other nutrients to the tissues. When tissues do not receive these essential nutrients, the skin that is deprived of oxygen and nutrients can be damaged and may eventually die.
A bedsore can develop in as little as 2 to 3 hours. Patients who cannot move on their own are at a higher risk for developing them because they cannot move themselves to relieve the pressure on their skin.
What Are Treatments for Bedsores?
Medical providers diagnose bedsores by inspecting the skin of patients who are at risk for developing them. When a patient is diagnosed with a bedsore the medical team and wound care team should evaluate the severity. Treatment will vary depending on the severity of the wound and may include:
Removing pressure from the affected area
Protecting the wound with gauze and other wound dressings
Keeping the area clean
Ensuring that the patient receives proper nutrition
Debridement (removing the damaged skin)
Skin grafts (transplanting healthy skin to the affected area)
Antibiotics to treat infections
Are Some Pressure Sores ‘Unavoidable’?
Whenever a nursing home takes in a new resident, a new patient assessment must be performed. The assessment should include an evaluation of the resident’s risk for developing bedsores. If the resident is at risk for developing bedsores, the resident’s care plan should include bedsore prevention. The care plan should also address considerations such as the resident’s hydration, nutrition, and hygiene. Resident’s with limited mobility should be repositioned every 2 hours. Some medical providers, in an effort to protect themselves from liability, may claim that the bedsores were unavoidable. However, in all but a few cases, this is simply not true. They are preventable through proper screening, early detection, and an involved and conscientious staff. When bedsores occur, it is more often the result of poor nursing care than an inevitable part of aging. Nursing homes that make bedsore prevention a top priority are unlikely to have patients who develop bedsores.
Some medical practitioners claim that, under certain circumstances, bedsores are unavoidable. These claims should be assessed by an independent third-party medical expert.
To be truly unavoidable, the medical provider must have evaluated the resident’s condition and risk factors for developing a pressure ulcer, implemented appropriate interventions to prevent the development of bedsores consistent with the individual needs and goals of the resident and recognized standards of practice, monitored the affected area, and revised the care plan as appropriate. If the nursing home or patient care facility failed to take all of these steps, they cannot claim that the bedsores were unavoidable.
What Can You Do If a Nursing Home Said Your Parent’s Bedsores Were Unavoidable?
In many cases, the nursing home failed to do everything necessary to prevent the development of pressure ulcers. Something is often missing, such as a risk assessment, the nursing care plan, or proper implementation of that plan. If the facility cannot show that it assessed the resident, developed an appropriate plan to prevent skin breakdown, implemented the plan, and revised the care plan as the resident’s condition changed, the facility cannot claim that the bedsores were unavoidable.
While it is true that some residents are at a higher risk of developing pressure ulcers than others, this simply means that it is that much more critical that the facility perform an adequate assessment and implement a plan to prevent skin breakdown.
Often the facility fails to perform an adequate risk assessment that triggers the care-planning protocols that will prevent pressure ulcers. If the initial assessment was not done or was not done properly, the care plan will be inadequate at preventing pressure ulcers from developing.
Robenalt Law — Seeking Justice for Victims of Nursing Home Negligence
Tom Robenalt started his litigation career representing nursing homes at a large firm in Cleveland. For the past 25 years, he has used that experience to help victims and the families of those injured by negligent health care providers.
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