Pressure ulcers, also known as bed sores, are an all too common occurrence in nursing homes. Fortunately, however, they are always preventable with good basic nursing care.
What Are They?
Pressure ulcers are caused by unrelieved pressure to the skin which compresses underlying blood vessels causing multiple levels of tissue damage and tissue death.
Patients who are permitted to remain in bed or in a wheelchair for an extended period of time get pressure ulcers. This is because their skin is compressed between the bed mattress or wheelchair cushion and the underlying bone structure.
The most common pressure ulcer locations are the back of the head, the spine, low back (sacrum), buttocks, heels, hips, knees and ankles.
They Go From Bad To Worse
Pressure ulcers are diagnosed as “Stages” based on their severity. They start as red marks and are classified as Stage I.
These are the easiest pressure ulcers to eliminate by merely turning and repositioning the patient at regular intervals in order to relieve the pressure.
If the patient isn’t turned and repositioned, the pressure ulcer moves to a Stage II, where the skin is blistered and broken.
Once again, the nursing staff, by turning and repositioning the patient, can stop the progression of the pressure ulcer and allow the skin and tissue to heal.
Failing to address the pressure at this stage permits the ulcer to progress to Stage III, which means that more tissue underlying the skin will die enabling the wound to deepen until it reaches close to the underlying bony structures.
Continued unrelieved pressure will cause the wound to deteriorate ever further until it reaches Stage IV, which is where healthy tissue is destroyed down to the bone.
Open pressure ulcer wounds are breeding grounds for infection. Many of the infections, in Stage IV pressure ulcer wounds, result in blood poisoning (sepsis) and patient death.
Preventable, Preventable, Preventable
Pressure ulcers are preventable with good basic nursing care, nothing extraordinary, just plain old fashioned basic nursing care.
However, nurses and nurse aides have limits as to the number of patients they can properly care for at any given time. Corporate failure to provide enough nurses and nurse aides (short staffing) accounts for the explosion in the number of pressure ulcers in nursing homes.
The Government Stops Paying Hospitals for Preventable Pressure Ulcers
Beginning October 1, 2008, Medicare stopped paying hospitals for hospital-acquired pressure ulcers. Medicare prohibits hospitals from billing patients for these costs.
Medicare calls these hospital-acquired pressure ulcers “never events” which means these pressure ulcers are preventable and should never occur to hospital patients.
Hopefully, Medicare will impose a similar non-payment regulation on nursing homes where most of the facility-acquired pressure ulcers occur.
Our Next Article
Our next article will discuss the importance of nutrition to the life expectancy of nursing home patients.
The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialogue with and among its readers.
