Simple steps to protect against pressures sores (bedsores) in a nursing home.

No one likes to think of the nasty terms, "pressure sores" or "bedsores", but they are a fact of life for residents in nursing homes. The question is whether anything can be done to prevent pressure sores for bedridden residents of nursing homes.  The answer is an unequivocal "YES".

First, what is a pressure sore?  A pressure sore is an area of skin breakdown that begins as redness and inflammation on the skin surface and can progress to dead, pussy skin that must be surgically debrided (cut off).  The most common site for a pressure sore is the buttocks or sacrum (area just above the buttocks).

Why do pressure sores develop?  Pressure sores develop as a result of unrelieved pressure on the affected part of the body.  For example, if a nursing home resident is immobile and he/she is not able to move, the weight of the resident's body places pressure on their buttocks and sacrum.  When the pressure point to the buttocks is not relieved, pressure sores begin as redness and inflammation.  Unless the resident is turned and repositioned on a frequent basis, i.e., once every two hours, the redness and inflammation progresses and a full-blown pressure sore is the result.

What can be done to prevent pressure sores?  The first step is to identify those nursing home residents "at risk" for developing pressure sores.  The nursing home must perform an assessment of each resident's risk of developing pressure sores upon his/her admission.  If the resident is immobile and unable to get out of bed, he/she is at increased risk for pressure sores and appropriate interventions should be taken.

Once a resident is identified as "at risk" for pressure sores, the next step is making sure that the appropriate interventions are implemented. The most important intervention for preventing pressure sores is turning and repositioning the resident at least once every two hours, which removes pressure from the areas of the body most prone to pressure sores, i.e., the buttocks. Other important interventions involve keeping pressure off of a developing pressure sore, such as positioning the resident on their side, and applying gauze and ointment to the pressure sore in its earliest stage.  If dead tissue develops on the edges of the pressure sore, the necrotic tissue must be surgically debrided to prevent the pressure sore from worsening.

Is a pressure sore preventable?  The federal government gives us the answer. Under federal regulations, the government refuses to pay for the treatment of Stage III and Stage IV pressure sores.  Why, you may ask? Because Stage III and Stage IV only occur as a result of the failure of the nursing home to treat pressure sores in their early stages.  A Stage III or Stage IV pressure sore should never happen when a nursing home resident is properly treated.

Every nursing home must have written policies for assessing the risk of pressure sores for each resident and the interventions that must be taken when a resident is classified as "at risk" for pressure sores.  In many cases, nursing homes violate their internal policies by failing to treat pressure sores.

Pressure sores are serious business.  Once a pressure sores progresses to Stage III or IV, they can be much more difficult to treat and sometimes lead to a downward spiral for the resident involving surgeries and hospital admission.  If you are concerned about pressure sores for a loved one, find out: #1: Has your family member been classified as "at risk" for pressure sores, and if so, #2:  What interventions are being taken to prevent pressure sores?

Your job as a patient's advocate is to make sure that the nursing home follows its internal rules for preventing pressures.  Don't accept anything less.