Discover how you can prevent a pressure sore from developing in your Kingston, New York nursing home
Let's start with the basics: pressure sores occur in areas of the body where there are bony prominences, such as the sacrum and buttocks. When a patient is bedridden or chairbound, the risk of pressure sores increases dramatically because there is unrelieved pressure on certain parts of the body. If the patient is unable to reposition their body, the likelihood of pressures sores goes even higher. These include people who are paralyzed, comatose, very weak, sedated or restrained.
When there is constant, unrelieved pressure on a part of the body, there is a lack of blood flow and redness and inflammation on the skin develops. If blood flow is cut off for more than one or two hours, the skin dies beginning with its outermost layer (epidermis). If untreated, the redness and inflammation on the skin develops into a sore, which in turn can penetrate the full-thickness of the skin down to the muscle layer and bone. Even worse, pressure sores often cause infection in the bone, known as osteomyelitis, which can be life-threatening.
There are four stages of pressures sores. A nurse usually measures the size and depth of the pressure sore to determine its stage and plan of treatment. Stage one is the earliest stage of a pressure sore where the affected skin has redness and inflammation. When treated, stage one pressure sores heal without progressing to stage three or four. Stage two pressure sores involve shallow skin loss, including abrasion, blisters or both.
Stage three pressure sores are the nasty, less treatable sores and involve full-thickness skin loss down to the layer of fat. Stage four is the most advanced stage of pressures sores and are characterized by full-thickness skin loss with exposure of underlying muscle, tendon or bone. Stage three and four pressures sores are totally preventable adn should never happen. This is not just my opinion: the federal government refuses to pay for Stage three and Stage four pressures sores through Medicare and Medicaid because it considers such sores to be caused by medical neglect.
Prevention of pressures sores is much easier than treating them. The key to prevention of pressures sores is identifying those patients at risk for pressure sores, such as bedridden and chairbound patients who are unable to reposition themselves. For patients at increased risk for pressure sores, the most important intervention is turning and repositioning them as frequently as once every hour to relieve the pressure on the affected part of the body.
The nurses should document that they turn and reposition bedridden patients once every two hours. Chairbound patients are at even greater risk of pressure sores and they should be turned and repositioned once every hour. If the nurses do not document the turning and repositioning of the patient, then they are not doing their job.
When a pressure sore is in its earliest stage (where there is only redness and inflammation on the skin), the patient should be positioned so that all of the pressure is removed from the pressure sore. For example, if the patient has an early stage pressure sore on their buttocks or sacrum, he/she can be positioned on his left or right side to keep pressure off the pressure sore.
It is crucial that the nurses do skin inspections at least on a daily basis to check for new pressure sores and monitor the status of existing pressures sores. The daily skin inspections must be documented by the nurses.
The patient's skin must be kept clean and dry because moisture increases the risk of developing pressure sores. In some cases, applying noncaking powder to skin in areas where two parts of the body pressure against each other (such as the buttocks and groin) help keep the skin in these areas dry.
If you have a family member who is bedridden or chairbound, such as a patient who just had a hip replacement operation, you want to make sure the nursing staff is paying close watch for the development of pressure sores on the buttocks and sacrum, in particular. You want to make sure that the nurses are turning and repositioning the patient at least once every two hours for bedridden patients and once every hour for chairbound patients. Be vigilant about protecting the rights of your loved one, as the nurses are often too busy or understaffed to turn and reposition all of their patients as required by protocol for patients at high risk for pressure sores.
You should make sure that the nurses are performing daily skin inspections to check for pressure sores in their earliest stage. If a pressure sore develops, you want to make sure the nurses keep the patient off of the affected part of the body and keep that area clean and dry.
Prevention is the key for pressure sores. If you suspect that your family member is at increased risk for a pressure sore, you should have a sit-down meeting with the nurses in charge of caring for your loved one and make sure that the appropriate interventions are taken to prevent a sore.