Bedsores/Pressure Ulcers

What is a bedsore?

The simplest answer is that a bedsore begins as a breakdown in the skin and underlying tissue due to a loss of blood supply to the affected area(s). A bedsore is also commonly known as a pressure injury, pressure sore, pressure ulcer, or decubitus ulcer. The term “bedsore” can be misleading because these types of injuries are also caused by prolonged sitting (e.g., too much time in a wheelchair).

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What causes bedsores?

In many instances, bedsores are the result of a unique combination of pressure and time, meaning, too much pressure on one area of the body for too long of a period. Such prolonged pressure can cause a loss of blood to the affected area, causing the skin to die. Once the skin dies, the affected area can become an open wound that is then subject to infection. These injuries are often seen in residents who are bedridden, immobile, unconscious, confined to a wheelchair, required to sit for prolonged periods (e.g., dialysis patients), unable to sense pain, unable to convey pain due to cognitive declines, subject to circulation problems, and/or wear casts for prolonged periods.

Do bedsores heal?

Bedsores range in severity and depend on a multitude of competing factors, including the resident’s physical condition, the presence of other diseases (e.g., diabetes), and the care required to address the wound. While a bedsore can heal under certain conditions, a bedsore can also become deep, extending into the muscle and bone. In many cases, however, bedsores are often very slow to heal if they heal at all. Some residents might require surgical intervention to assist in the healing process. Other bedsores can become infected, causing fever and chills. An infection that begins in the affected area can also spread through the body, causing a host of additional problems.

The Braden Scale Assessment

To ascertain the unique circumstances of each resident, facilities typically use an assessment commonly known as the “Braden Scale” assessment for predicting pressure sore risk. The Braden Scale encourages a facility to assess a resident for sensory perception, skin moisture, degrees of physical activity, mobility, nutrition, and the ability to independently reposition themselves in a bed or wheelchair. Because the Braden Scale only accounts for a snapshot in time (i.e., the day the facility completes the assessment), it is important for facilities to engage in frequent reassessments and to revisit the assessment when there is a change in the resident’s condition. In addition, it's critical that a facility accurately complete the assessment to give the resident the best chance of avoiding the pain and suffering associated with bedsores.

Are there interventions that can limit the occurrence of bedsores?

Bedsores are often caused by substandard care and treatment. The following non-exhaustive list of interventions may reduce the occurrence of bedsores:

• For residents that are immobile and require assistance, turning and repositioning the resident every 2 hours or consistent with a physician’s orders.

• Providing pressure-reducing pads for wheelchairs and beds.

• Keeping the skin clean and dry

• Providing good nutrition to promote healing.

It is also important that facilities engage in regular skin checks, looking for areas of redness and taking appropriate action when caretakers identify potential problems.

Where on the body are bedsores commonly seen?

Bedsores are commonly seen in the following areas of the body:

• Buttocks area (on the tailbone or hips)

• Sacral area (near the lower back and spine)

• Heels of the feet

• Shoulder blades

• Backs and sides of the knees

• Back of the head

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What are the stages of a bedsore?

Bedsores are divided into 4 stages, from least severe to most severe, and are “staged” according to their appearance. The stages are as follows:

• Stage 1. The area looks red and feels warm to the touch. With darker skin, the area may have a blue or purple tint. The resident may also complain if he or she can do so, that the affected area burns, hurts, or itches.

• Stage 2. The area looks more damaged and may have an open sore, scrape, or blister. The resident complains if he or she can do so, of significant pain and the skin around the wound may be discolored.

• Stage 3. The area has a crater-like appearance due to damage below the skin’s surface.

• Stage 4. The area is severely damaged, and a large wound is present. Muscles, tendons, bones, and joints can be involved.  The affected area is at significant risk for infection.

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A wound is considered “unstageable” when the base of the ulcer is covered by slough (dead tissue, usually cream or yellow in color) or eschar (dry, black, hard necrotic tissue). 

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A bedsore may also be classified as a deep tissue pressure injury when there is not an open wound, but the tissue beneath the surface has been damaged. In these instances, the skin may look purple or dark red, or there may be a blood-filled blister.

If you or your loved one suffered from a bedsore at the hands of a nursing home or assisted living facility, contact the experienced attorneys at FIDJ, before it’s too late.

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*The information contained herein is not, and must not be construed as medical advice.