Bed Sore Articles

Wireless Patient Monitoring Holds The Key To Better Patient Care & Possibly The Prevention Of Pressure Ulcers

Many hospitals and nursing homes suffer from understaffing.  These understaffed facilities are unable to provide the best possible care to its patients and residents.  This leads to an increased number of preventable deaths and injuries.  One possible tool to help combat this problem is the use of remote monitoring devices.  Inadequate supervision and staffing at nursing homes is no excuse for poor patient care.  (See “Are assisted living facilities responsible for the prevention of bed sores in their patients”)

Remote monitoring devices allow for wireless patient monitoring.  The monitors typically track temperature, pulse, blood pressure, glucose, and personal data (weight, pain, drugs).  The system can record and transmit data to doctors.  In the case of patients who do not live near medical support, it can transmit vital information to doctors to alert them of any change in patient status.  For nursing home residents, remote monitoring can help staff better monitor residents and focus their attention on the patients who need medical assistance.  The system is particularly helpful for monitoring patients with chronic diseases including diabetes, heart failure, and patients recovering from strokes.  In addition, remote monitoring prevents unnecessary trips to the doctor and hospital, which can reduce costs.

As new technologies are incorporated into patient care, there must also be standards set on how to monitor data and how often.  Even though doctors and nurses do not need to physically take a patient’s vital signs, they still need to review the data.  However, overall, this will free up a lot of time for doctors and nurses because of reduced need for office visits.

The FCC (Federal Trade Commission) delivered its National Broadband Plan to Congress in March.  The FCC promotes broadband to save money in healthcare with the use of remote monitoring of health records and patients’ vital signs.  Together, remote monitoring and electronic health records could save as much as $700 billion over 15-25 years.  (See “Is It Time For Nursing Homes To Embrace Electronic Medical Records?”)

Remote monitoring offers one option to improve patient care and safety, while also reducing costs.  But, it is unclear how likely the use of remote monitoring will be in nursing homes in the near future.  Until then, it is critically important that nursing homes are properly staffed, so that residents receive the proper care and supervision to achieve or maintain the best possible health and prevent medical conditions such as pressure ulcers.

Sources:

Broadband.gov: Broadband & Health Care

Med Health World: Patient Monitoring Without the Wires-Is Ultra Wideband Frequency the Future?

Bed Sore FAQ

Nursing Homes Abuse Blog: Is It Time For Nursing Homes To Embrace Electronic Medical Records?

Medical News Today: Remote healthcare monitoring not so distant

New York Times: Remote Control for Health Care

Nursing Homes Abuse Blog: Are assisted living facilities responsible for the prevention of bed sores in their patients

Read more »

Who’s To Blame For Bed Sores In The Obese? Or Are They An Inevitable Part Of Being Fat?

An article published in the Las Vegas Sun, painted an unfortunately common set of circumstances; an overweight patient goes into a hospital for a medical procedure– only to acquire pressure sores during their stay. Sure, the same scenario can (and most certainly does) occur with people of average stature, but there definitely is a disproportionate number of obese patients who enter a hospital or nursing home only to develop a lingering souvenir.

The sun article concentrates on 60-year-old Tyrone Bush, a maintenance man, who was admitted to Desert Springs Hospital for a quadruple heart bypass surgery in 2008. It was during Bush’s recovery at the hospital, that he developed multiple bed sores (or pressure sores, pressure ulcers, decubitus ulcers) on his buttocks.

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Pressure Mapping System Can Help Identify Areas Of The Body Prone To Develop Pressure Sores

Pressure sores are a very serious– yet preventable problem that plagues many nursing home and hospital patients.  Now, new technology in the form of a Pressure Mapping System can help identify areas on a patient’s body that may form pressure sores.  The new technology would assist doctors in preventing bedsores before they start to form.

Pressure sores (also known as decubitus ulcers, bedsores, and pressure ulcers) are areas of skin and tissue that have been damaged by inadequate blood flow because of sustained pressure.  Nursing home residents and hospital patients are at increased risk for pressure ulcers because of decreased mobility, wheelchairs, and bed confinement.

Common areas to suffer from decubitus ulcers are the:

• Buttocks
• Heels
• Lower back
• Shoulders
• Hips
• Knees
• Ankles

Pressure mapping is a useful tool for doctors to help assess patients who are susceptible to developing pressure sores and  making an early diagnosis in patients with existing pressure sores.  A pressure map helps reveal what is happening underneath a patient’s skin.  It allows doctors to see areas of pressure under a patient’s skin that are not yet apparent on the skin’s surface.

The mapping device is actually a thin mat that has sensors attached to it.  The mat is placed between the patient and the bed, wheelchair, or other seating surfaces.  These sensors, which are attached to a computer, read the amount of pressure exerted on them, creating a color-coded map of the pressure distribution.  This image can help a caregiver determine high-pressure areas.

Then, the caregiver can implement preventative measures so pressure sores do not occur.  Pressure-reducing measures include changing positions more often, changing body position, changes in equipment, using special cushions, pads, mattresses, and beds that relieve pressure, and using foam, air, or water-filled devices to cushion a wheelchair seat and foot rests.

Pressure mapping systems are not without their problems.  There are some concerns with the lack of standardization in how different devices report pressure readings.  In addition, some devices simply report an average pressure reading over a larger area, which might under-report the pressure in small bony areas surrounded by lower pressure areas.  Therefore, pressure maps should be used as just one tool in effectively diagnosing and preventing pressure sores.  It is important that doctors and caregivers still perform detailed skin inspections for signs of pressure sores.

Pressure mapping systems can help prevent dangerous and painful pressure sores, which improves quality of life and reduces the cost of treating pressure ulcers.  However, some facilities might not be able to afford the high cost of such a system.  Ridge Meadows Home Care Team was able to purchase a $17,000 Pressure Mapping System because of a $10,000 donation.  When choosing a nursing home facility, it is important to ask about preventative measures such as a pressure mapping system, especially if you are at increased risk for pressure sores.

Sources:

Maple Ridge News: Pressure Mapping System to Treat, Prevent Bed Sores

Lippincott’s Nursing Center: Wound and Skin Care – Can pressure mapping prevent ulcers?

Northwest Regional Spinal Cord Injury System: Picture This . . . Pressure Mapping Assessment for Wheelchair Users

Optimal Positioning: Wheelchair Seating Comfort and Pressure Mapping

Read more »

Is $28 Million In Punitive Damages Enough To Punish A Nursing Home That Allowed Patient To Develop Infected Pressure Sores?

Is $28 million in punitive damages enough to punish Colonial Healthcare of Auburn for the abuse and death of an elderly resident?

Well according to a California jury, the answer is ‘yes’.  $28 million is the amount of punitive damages the jury awarded in the elder abuse and wrongful death case (Sacramento Superior Court) against Colonial Healthcare of Auburn and its parent company Horizon West of Rocklin.  This case revolved around the abuse and death of Ms. Frances Tanner, a 79-year-old resident, who died from an infected bedsore.  Punitive damages were awarded because the jury determined that the nursing home was “malicious, oppressive, or fraudulent.”  In addition, the jury awarded Ms. Turner’s daughter, Elizabeth Pao, $1.1 million for loss of companionship and her mother’s pain and suffering.

Ms. Frances Tanner was admitted to Colonial Healthcare of Auburn in March 2005 with a diagnosis of dementia.  Then, in September 2005, Ms. Tanner fell and broke her hip.  The nursing home did not conduct a timely assessment of her injury, which resulted in a delay in treatment.  It took eight days after Ms. Tanner’s fall for the nursing home to diagnose her with a hip fracture.  It was at this point that staff members also discovered a bedsore (also known as a pressure sore, decubitus ulcer, or pressure ulcer).  A few weeks after undergoing hip surgery, Ms. Tanner died from an infected bedsore.  (See “Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?”)

Bedsores are a very serious and dangerous problem for nursing home residents, especially those who have limited mobility.  When Ms. Tanner suffered a fall, the nursing home should have first conducted a thorough examination, with special attention given to a possible hip fracture.  Hip fractures are a very common injury in elderly nursing home residents because of weak bones.  Second, nursing home staff should have implemented measures to prevent bedsores during her recovery because of Ms. Tanner’s reduced mobility.

It is unthinkable that it took the nursing home eight days to discover the hip fracture and bedsore.  Then, what is even worse is that the nursing home facility allowed Ms. Tanner’s bedsore to progress to such a level that the resulting infection actually killed her.  (See “Are the development of bed sores during a nursing home admission an indication of nursing home neglect?”)  Decubitus ulcers are incredibly painful, and it is likely that Ms. Tanner spent her final days in pain from her hip fracture and infected bedsore.

Bedsores are a preventable injury.  When a nursing home resident suffers an injury that leads to reduced mobility, the nursing home should implement special preventative measures to ensure that no bedsores occur.  In fact, nursing homes must do this.  They must take steps to prevent bedsores.  Then, if a resident does suffer from a bedsore, the facility must provide proper care and treatment to ensure that the bedsore heals and does not worsen.  Healthcare of Auburn directly contributed to the death of Ms. Tanner.  The elder abuse and wrongful death charges are important to hold the facility responsible, and the punitive damages help to further punish the nursing home and prevent future tragedies.  However, they do nothing to bring Ms. Elizabeth Pao’s mother back.

Resources:

The Sacramento Bee: Jury Hits Auburn Nursing Home with $28 Million in Punitive Damages

The Washington Examiner: Jury Awards $29.1 million in nursing home death

Bed Sore FAQs: Are the development of bed sores during a nursing home admission an indication of nursing home neglect?

Bed Sore FAQs: Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?

Read more »

Simple preventative techniques can drastically reduce the rate of hospital-acquired decubitus ulcers

Though surely an unanticipated complication, hospital-acquired decubitus ulcers (also referred to as: pressure ulcers, pressure sores or bed sores) remain a tremendous problem for patients and the hospital itself.  Acknowledging the negative impact of decubitus ulcers, Texas Arlington Memorial Hospital set out to create a program to reduce the rate of hospital-acquired decubitus ulcers.  Though hardly high-tech, the hospital cut the rate of decubitus ulcers by 63% utilizing the following techniques:

• Screening all new admission for decubitus ulcers
• Encouraging patients who are physically able to use the toilet as opposed to diapers
• Empowering all hospital staff: physicians, CNA’s, RN’s and others to identify and document all signs of early stage decubitus ulcers when caring for patients
• Implementing extra skin checks for physically disabled patients or those who constantly use medical equipment like oxygen masks or tubing
• Analyzing all patient records on a quarterly basis to determine which preventative techniques are working and those that are not

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Nursing Home Resident Dies From Improperly Treated Pressure Sores During Short Rehab Stay

Mr. Newton K. McManus Jr. died on May 31, 2008, less than one month after being admitted to Caseyville Nursing and Rehabilitation Center, an Illinois nursing home, on May 8, 2008.  Mr. McManus spent his final days in pain, suffering from pressure sores, leg ischemia (inadequate blood flow, resulting in pain and non-healing wounds), and a urinary tract infection.  Ms. Shirley McManus filed a wrongful death lawsuit against the facility in St. Clair County Circuit Court, seeking$150,000.

Caseyville Nursing and Rehabilitation Center is a 150-bed facility located in Caseyville, Illinois has a one-star rating from Medicare Nursing Home Compare, which is a much below average rating.  Not unsurprising considering the poor treatment Mr. McManus received, Caseyville had twelve health deficiencies between January 2009 and March 2010, which is four more than the Illinois average and the U.S. average.

Mr. McManus seems to be the victim of neglect.  In the final month of his life, he suffered from a series of health problems including:

• Bed sores
• Urinary tract infection (See “Untreated Urinary Tract Infections in Nursing Home Patients May Result in Urosepsis”)
• Malnutrition (See “Can malnutrition cause bed sores?” and “Inadequate Nutrition & The Development of Bed Sores in Nursing Home Patients”)
• Dehydration (See “Can dehydration contribute to the development of pressure sores?”)

Bedsores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) are a very serious and preventable problem that affects many nursing home residents.  Nursing homes are required to ensure that residents do not develop pressure sores and provide treatment and services to promote healing and prevent infection for residents with existing pressure sores.  Oftentimes, these victims do not receive adequate care and services that would prevent these painful and dangerous injuries.  If not properly treated, decubitus ulcers can progress rapidly, damaging tissue and bones and cause sepsis or even death.  It is saddening that this is how Mr. McManus spent the final days of his life, in pain and agony.  Coupled with the horrible physical pain was the victim’s deteriorating mental state and distress.

Ms. Shirley McManus is now suing the nursing home facility for wrongful death, alleging that the facility committed several negligent acts that resulted in his death.  Her lawsuit alleges that the nursing home failed to provide adequate care, failed to protect Mr. McManus from abuse and neglect, failed to notify his doctor of a change in physical condition, failed to create a care plan that addressed his pressure sores, and also failed to maintain his body weight.

Situations like this should not occur in nursing homes.  Residents are entitled to receive necessary care and services in order to attain or maintain the best possible physical, mental, and psychosocial well-being.  If you or a loved one are not receiving this minimum level of care and have suffered injury, you may be entitled to compensation

Sources:

Madison St. Clair Record: Woman Sues Caseyville Nursing Home Over Man’s Death

Illinois Department of Public Health: Caseville Nursing & Rehab Ctr

Medicare Nursing Home Compare: Caseyville Nursing & Rehab Ctr

Untreated Urinary Tract Infections in Nursing Home Patients May Result in Urosepsis

Can malnutrition cause bed sores?

Inadequate Nutrition & The Development of Bed Sores in Nursing Home Patients

Can dehydration contribute to the development of pressure sores?

Read more »

Survival rates for sepsis patients is dependent on how quickly the medical facility identifies the problem and implements treatment

Many of our nursing home negligence and medical malpractice cases involve patients who may have developed a pressure sore only to be confronted with another medical problem– sepsis.  Sepsis is a severe infection that effects the complete body.  Due to the open wounds that accompany advanced pressure sores (also called bed sores, decubitus ulcers or pressure ulcers), provide the perfect entry way for infection to enter the body.

Sepsis is a deadly, yet surprisingly common medical condition.  According to a recent sampling of hospital patients:

• Sepsis is the 10th leading cause of death in the U.S.
• 33% of people who contract sepsis will die from the disease
• Medical expenses to treat sepsis cost approximately $17 billion per year

The Banner Desert Medical Center in California recognized the substantial problems associated with sepsis and has begun to implement a prevention and treatment program.  Believed to be the first of its kind, the California hospital uses a scientific formula to detect warning signs that indicate a patient is at risk for contracting sepsis.  The diagnostic program evaluates:

• changes in body temperature
• increases in heart rate
• changes in respiratory rate
• decreases in white blood cell count

After the early symptoms of sepsis are identified, the hospital is able to rapidly administer medical treatment and greatly improve the patients survival rate.  In the first two months of its use at Banner Medical Center, the hospital credits the new program with the early detection of sepsis in 60 patients  and likely a substantial number of lives as well.  Read more about this important development in sepsis prevention here.

Hopefully this sepsis detection tool can be applied to patients in a nursing home setting as well.  Too often the implementation of medical treatment for nursing home patients is delayed due to inadequate training of staff and insufficient medical equipment.

Related Bed Sore FAQ’s:

Is sepsis related to bed sores?

Are bed sore patients at risk for amyloidosis?

Why is a colostomy needed for patients with severe bed sores?

Why are physically disabled patients at risk for developing bed sores?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Nursing home neglect and medical malpractice alleged in wrongful death case involving the development and advancement of decubitus ulcers during admission to nursing home and hospital

Philadelphia jurors have spoken in a case involving the development of decubitus ulcers during a hospitalization and deterioration during a subsequent stay at a nursing home.  Not only did they speak up, but the jurors stood up in a loud way, slapping $5 million in punitive damages on top of a $1 million compensatory award against the Jeanes Hospital and Hillcrest Convalescent Home.

In the case believed to be the first of its kind decided by a Philadelphia jury, the punitive damages were allocated: $1.5 million against the hospital and $3.5 million against the nursing home.

According to the lawyer for the man’s family, Steven R. Maher, Jeans Hospital failed to diagnose the man’s urinary tract infection that contributed to the development of bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) and then the man was transferred to Hillcrest Nursing Home where the bed sores worsened.  After a courageous battle attempting to heal the decubitus ulcers at home for more than two years, the man succumbed to complications related to the decubitus ulcers.

Jeanes Hospital is part of the Temple University Health System and Hillcrest is owned by Genesis HealthCare Corporation, a large nursing home operator in the Northeast.

Unlike compensatory damages that are intended to compensate an injured party for their loss, punitive damages are only awarded in situations where a court determines the conduct to be outrageously negligent or reckless. In cases involving decubitus ulcers, punitive damages may be appropriate when staff repeatedly fail to tend to their duties over extended periods.  No doubt that the plaintiff’s lawyers were persuasive, but my guess is that the testimony and photographs (if any) really incited feelings of rage.

Additionally, this case is important because too often we see different medical facilities point their fingers at the other facility.  Here we see that even when a patient arrives at a nursing home in a less that ideal condition, facilities still have an obligation to provide the patient with quality care to prevent further deterioration.

Related Bed Sore FAQ’s:

What can hospitals do to reduce the rate of bed sores in their facilities?

If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?

After I become aware of a bed sore, should I photograph it?

Are the development of bed sores during a nursing home admission an indication of nursing home neglect?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Son blames under-staffing at nursing home for development of mother’s pressure ulcers and infection

Without a doubt, staffing is the number one predictor of the the type of care patients in nursing homes, hospitals and assisted living facilities will receive.  High-tech medical equipment and expansive medical facilities mean nothing without a team of properly trained personnel to tend to patient needs.

In this sense, the son of a deceased nursing home patient blames ‘under-staffing’ as the reason why his mother fell and subsequently developed pressure ulcers at the facility.  As the special administrator of his mother’s estate, Gary Brown filed a nursing home negligence lawsuit against a county operated nursing home in Nebraska alleging that his mother’s injuries and death could have been prevented had the facility had adequate staff.

As is frequently the case in with injuries occurring in the nursing home setting– one error leads to the development of another.  In the case of this lawsuit, it is alleged that after the facility failure to supervise the woman resulted in a fall and hip fracture.  After the hip was surgically repaired, the facility failed to acknowledge the fact that the woman’s immobility that accompanied put her at risk for developing pressure ulcers (also referred to as pressure sores, decubitus ulcers or bed sores) during her recovery at the facility.

The facilities negligence continued even after the pressure ulcers developed as the pressure ulcers advanced and became infected.  Further complicating the situation is the fact that the the facility failed to notify the woman’s son or personal physician of her pressure ulcers.  Finally, Mr. Brown claims that the pressure sores contributed to his mother’s death.

Read more about this nursing home negligence lawsuit involving the development of pressure ulcers here.

Nursing Homes Obligation To Prevent  & Treat Pressure Ulcers

Every patient coming into a nursing home must be assessed to determine their risk for developing pressure ulcer and a care plan must be developed to meet the patients needs.  When facilities are inadequately staffed or staff never receives proper training, many of the preventative measures set forth in a care plan never get done and patient injury frequently ensues.

Pressure ulcers are a known problem facing patients in nursing homes and hospitals with limited mobility. Pressure ulcers may develop when patients are left in one position for extended periods of time.  Patients who remain in one position for extended periods are at risk for developing pressure ulcers as limited blood flow to the area results in the gradual decay of tissue.

Consequently, many nursing home patients need to be ‘turned’ on a regular basis.  Many facilities have charts to help staff keep track of the re-positioning schedule for each resident.

In order to reduce the incidence of pressure ulcers, nursing home residents should be:

• Kept clean and dry, particularly those patients who may be incontinent
• Moisturized daily
• Washed regularly with mild soap and water
• Changed positions on a regular basis to chances of unrelieved pressure
• Kept well fed and hydrated
• Kept the bed elevation as low as possible- this reduces pressure on the sacrum and buttocks– areas where pressure ulcers frequently develop

Related Bed Sore FAQ’s:

What are the signs of infection for people who have bed sores?

What should I do if my family member develops bed sores during an admission to a nursing home?

What areas of the body are prone to develop bed sores?

What type of legal recourse does a person with bed sores have?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

New York jury awards $19m to family of man who developed advanced bed sores during nursing home admission

If you ask most people what a ‘bed sore’ is, you may get a lot of blank stares and shrugs.  Truth is, most people probably have never seen a severe bed sore.   However, when people actually see the gruesome photos of rotting flesh on a person’s backside that expose underlying layer of skin and bone they probably will next forget the image.

Similarly when people hear of the ongoing medical procedures that are necessary to heal the wound, and the pain experienced by the individual, they really begin to understand the real impact of this medical condition. The reality is that bed sores kill patients in nursing homes and hospital– needlessly.

The visual impact and physical devastation to the man that was caused by the bed sores is likely what caused a New York jury to make their substantial award in a lawsuit filed by the family of a deceased man who developed bed sores in a nursing home.

The man’s daughter’s Margaret Whitehurst, said her father’s medical condition quickly declined during his nine month admission to Brooklyn, NY facility.  “He walked in on two legs and a cane.  He was 237 pounds.  When we got him back, he was 148 pounds and had holes all over his body.”

During the trial, the jury heard testimony from the man’s family and physicians regarding the severity of his bed sores (also called: decubitus ulcers, pressure ulcers or pressure sores), and also from a handwriting expert who testified about how the man’s nursing chart was altered.  According to the handwriting expert’s testimony, the admission paperwork was altered to look as though the man entered the facility with bed sores, although his family and physicians strictly denied that fact.

Certainly, hearing that the nursing home records were altered in this matter must have swayed the jury to make such a large award for punitive damages.  Punitive damages are usually awarded after a judge has given the plaintiff leave to file a prayer for such.  Unlike compensatory damages intended to compensate an injured party, punitive damages are intended to punish the wrongdoer.

Related Bed Sore FAQ’s:

Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?

What are the causes of bed sores?

If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Problems persist in Chicago nursing home with track record of providing poor nursing care

If you’ve ever wondered just how bad life in a poorly rated nursing home is, take a look at a recent investigative article by Sam Roe of the Chicago Tribune.   Mr. Roe’s article chronicles life at Berwyn Rehabilitation Center, a Chicago nursing home that received one-star in all major categories by the Medicare rating system.  The article illustrates what living conditions are like for patients in a poorly rated facility.  Sadly, despite the poor ratings and dangerous living conditions, facilities such as Berwyn Rehabilitation continue to receive federal funding.

The star-ratings of nursing home is a recent feature on Medicare’s Nursing Home Compare website that has information on the more than 16,000 nursing homes in the United States.  Nursing homes are rated on a one to five- star system in categories important to patient care based on information contained in: staffing levels, nursing home surveys and overall quality measures.

Surely, the Medicare ratings assigned to facilities such as Berwyn Rehabilitation can only tip-off patients as to what may lay behind the doors of the facility, but the details of the living conditions chronicled during inspections at Berwyn Rehabilitation certainly indicate the the low ratings may be well founded.

According to Illinois Department of Health (IDPH) surveys conducted at Berwyn Rehabilitation Center, the regulatory agency noted 29 violations of patient safety and care regulation.  IDPH inspectors noted the serious violations:

• Decubitus ulcers (bedsores, pressure ulcers, pressure sores) on the buttocks on incontinent patients
• Bruises of unknown origin on the legs and arms of patients who were primarily confined to bed
• Incontinent and non-incontinent patients sitting in urine and feces for extended periods
• Patients suffering from chronic pain who were never administered any pain relieving medication despite physician orders for such
• Dirty urinary catheter tubing
• Dirty dressings covering pressure sores and inadequate documentation as to when the dressings had been changed
• Dangerous bed rail usage– improperly fitted bed rails used on beds allowing patients to potentially become entrapped between the rails and bed mattress

In response to the poor Medicare ratings and survey findings, a new nursing director was recently installed at Berwyn Rehabilitation.  “This nursing home was really bad,” according to Anjanette Miller, the recently appointed director of nursing.  Not surprisingly, Ms. Miller attributes staffing problems as the major culprit behind the facilities poor reputation.  Nursing home staff “were punching in and doing nothing,” she added.

Despite a recent shake-up with the appointment of a new director of nursing and implementation of new management team, problems at Berwyn Rehabilitation Center persist.  After these new measures were put into place an inspection of the nursing home confirmed patient safety violations remain.  For example, a resident became entrapped between an inflatable mattress and the bed rails on his bed even after earlier inspections had brought this problem to the attention of the facility.

An autopsy conducted by the Cook County Medical Examiner determined that the patients death was due to the suffocation related to the entrapment.  An investigation into his death revealed the facility was using improperly fitted rails that were arbitrarily replaced by a nursing home employee shortly before his death.

Certainly, as we can see in situations such as this, sometimes a meager Medicare rating is well deserved.

Related Bed Sore FAQ’s

How should medical professionals document a healing bed sore?

What types of wound dressing can be used on bed sores?

What are the signs of infection for people who have bed sores?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Short-term nursing home admission results in deterioration of pressure sores and sepsis

The family of a former nursing home patient at Caseyville Nursing and Rehabilitation has filed a wrongful death lawsuit against the facility in connection to the death of their family member.  The nursing home negligence lawsuit claims that the within a week of admission to the nursing home, the woman’s pressure sore on her heel and buttocks had become an open wound (stage 4 pressure sore) and the woman become septic.

In particular, the lawsuit claims that Caseyville Nursing and Rehabilitation was negligent in the following manners:

• Failing to conduct a skin assessment when the woman entered the facility
• Inadequately staffed their facility
• Failed to develop a comprehensive ‘care plan’ for the patient
• Failed to notify a physician regarding the deterioration in the woman’s medical condition

Short-term or ‘respite care’ admissions to nursing homes are a common service that many facilities provide.  When patients are admitted to nursing homes for a period of days or weeks, the facility still has the same responsibilities to care for them as they do for their longer-term patients.  Even for short-term admissions, nursing homes should conduct an assessment of the patients needs and create a care plan with the assistance of the patients family and physician to assure all of the patients needs are met.

Read more about this nursing home lawsuit involving a septic patient here.

Related Bed Sore FAQ’s

Why do bed sores commonly develop on the buttocks?

What are the stages of bed sores?

Is sepsis related to bed sores?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Significant award made in nursing home arbitration case involving the development of advanced pressure sores and gangrene

Unlike most personal injury cases where a determination regarding the monetary damages an individual or family is entitled to receive is determined by a judge or jury, damages in an increasing number of nursing home negligence cases is now being made via an individual arbitrator or panel of arbitrators.

Many nursing home patients may unknowingly consent to mandatory arbitration agreements in admission paperwork.  Under the terms of an arbitration agreement, an individuals right to a jury trial is forfeit and settled via an out-of- court arbitration system.  Proponents of arbitration agreements tend to be nursing homes, who believe a dispute resolved via arbitration will be more favorable to them than before a jury.

Arbitration agreements created by a nursing home will set forth the arbitration procedure.  In cases involving the use of a single arbitrator, the arbitrator is pre-determined by the nursing home.  Some arbitration agreements set forth that disputes are to be determined via an ‘arbitration panel’ (usually three people) where both the nursing home and the patient choose an arbitrator, and a third arbitrator selected by agreement of the arbitrators.

For the most part, nursing home negligence disputes resolved via arbitration tend to have lower values than similar disputes tried before juries.  Because some arbitrators receive ongoing business from nursing homes, it has been suggested that their willingness to award significant damages may be limited.  Consequently, nursing home arbitration agreements tend to be vigorously fought by plaintiffs (injured parties, initiating a lawsuit) as unfair and in violation of personal rights granted under the Constitution.

In a break from traditionally conservative awards in wrongful death matters, a three-person arbitration panel awarded over $2.7 million in damages to the family of a nursing home patient who died in March, 2005 from complications related to gangrene and advanced pressure sores that developed during an admission to High Point Health Care and Rehabilitation Center in Tennessee.

The significant arbitration award was made against the nursing home itself and its parent company (Mariner Health Care), the nursing home management company (Mariner Health Care Management) and the nursing home licensee (National Heritage Realty Company).  At the arbitration, the nursing home patients estate claimed that all entities were guilty of: negligence, violation of the Tennessee Adult Protection Act (TAPA) and medical malpractice.

For victims of nursing home abuse and neglect, this arbitration decision is very significant as it sends a message to nursing homes that they can no longer be assured of conservative awards by arbitrators.  Although rarely awarded in arbitration matters, this arbitration panel made an award for punitive damages (an award made to punish the wrongdoer as opposed to compensate) against the nursing home as well.

The $2.7 million nursing home arbitration award is comprised of the following:

• $250,000 for TAPA violations
• $400,000 in attorneys fees for intentional, malicious or fraudulent misconduct resulting in TAPA violations
• $626,396.32 for medical malpractice
• $1,500,000 punitive damages

Related Bed Sore FAQ’s

If bed sores are not timely treated, can gangrene develop?

What are the signs of infection for people who have bed sores?

Is sepsis related to bed sores?

Can bed sores be fatal?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Hospital patients are more likely to develop decubitus ulcers today than they were 10 years ago

The Agency for Healthcare Research and Quality released a report on hospital-acquired decubitus ulcers that has conclusively determined that hospital patients today are more likely to develop a decubitus ulcer during their admission than their counterparts 10 years ago.  In fact, the rate of decubitus ulcers (pressure ulcers, pressure sores or bed sores) acquired during a hospitalization has increased by more than 80% from 1993 to 2006! 

In addition to higher overall rate of decubitus ulcers, the study also revealed the following information regarding the development of hospital-acquired decubitus ulcers:

• In 2006, there were 503,300 hospital patients were admitted with a primary diagnosis of ‘decubitus ulcer’ — this marks an increase of approximately 80% since 1993.
• The cost of treating decubitus ulcers at hospitals was approximately $11 billion annually.
• The overwhelming majority of cases (>90%) involving decubitus ulcer care involved patients who were admitted for unrelated medical care.
• Patients discharged from a hospital following treatment for a decubitus ulcer generally fared worse than other types of patients with a lower survival rate within the first year of hospital discharge.
• Patients who developed decubitus ulcers during a hospitalization tended to be older.  72% of decubitus ulcer patients over 65-years old had a secondary diagnosis of decubitus ulcers and 56.5% of elderly hospital patients who received decubitus ulcer treatment was due to a primary diagnosis of decubitus ulcers that had developed during their hospital stay.
• Medicare was the largest payer of for care of patients with decubitus ulcers– paying approximately 75% of all charges related to decubitus ulcer care.
• Younger patients who received treatment for decubitus ulcers tended to be paralyzed or have spinal cord injuries.

Most cases involving the development of decubitus ulcers during a hospitalization result from the hospitals failure to monitor at-risk patients and implement interventions on a timely basis.  Consequently, patients who develop a decubitus ulcer during a hospital admission may be entitled to pursue against the hospital based on medical negligence.

Related Bed Sore FAQ’s

Where can I learn more about the laws applicable to people who develop bed sores in nursing homes or hospitals?

What legal action can be taken if a bed sore developed during an admission to a long-term care facility?

Why are physically disabled patients at risk for developing bed sores?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Nurse faces criminal charges after she fails to obtain medical treatment for bedsore patient

Criminal charges are expected to be filed against Virginia Munger, a CNA employed by Homewell Senior Care, after prosecutors concluded that Munger failed provide any medical intervention for an elderly patient she was responsible for caring for.

The criminal investigation followed the bedsore-related death of an elderly home-based patient.  In the course of the investigation, prosecutors learned that Munger deliberately ignored bedsores (also referred to as: decubitus ulcers, pressure ulcers or pressure sores) on the patient for at least six months prior to her death.

Home Care Nursing Services

In recent years, a new trend has emerged in the senior care industry with the increase in home-based nursing services.  Many seniors today, seek home-care services as a way of living in the comforts of their home for longer periods.  Home-care senior services companies provide a broad range of services including: skilled nursing care, medication management, cooking, homemaking services, senior sitting services and transportation services.

Home care services for seniors can be a great alternative to nursing homes, group homes or assisted living facilities, but it is important for the patient and their family to realistically assess their true needs and confirm that the agency can meet those needs from the start.

Similarly, staff at home care service companies should conduct an assessment of each perspective patient to determine what the patients real needs are and make a determination if the company can indeed meet those expectations.  A plan of care should be prepared by the home care agency to assure the needs of their clients are regularly met.  The care needs of each client should be re-assessed on a regular basis to ensure the that the patients needs can be met on an ongoing basis.

In the case above, fault surely lies on the shoulders of the CNA responsible for caring for the elderly woman.  Nonetheless, I also believe the senior care company who employed the CNA should shoulder some of the responsibility as well.  If in fact the company allowed the CNA to essentially work in isolation– without the oversight of supervisors, the company would likely be found negligent for failing to supervise its employees.

On the other hand, if the senior company did in fact send a supervisor to periodically check-in on this woman– yet failed to observe the bedsores or take any invention– I think similar criminal charges would be deserving.

Related Bed Sore FAQ’s

Is an autopsy necessary when a family suspects bed sores caused the death of a family member?

Can bed sores be fatal?

Does the family of a deceased person who had bed sores at the time of his death have any legal recourse against the facility where the wounds developed?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Lawsuit ensues after patient develops decubitus ulcers on back and heels during rehab stint in nursing home

An orthopedic rehabilitation patient who developed multiple decubitus ulcers on his back and heels has filed a lawsuit against the nursing home where the wounds developed.

The lawsuit alleges that Highland Health Care Center and its parent company Covenant Care Midwest failed to implement preventative measures to avoid the development of decubitus ulcers during a short-term admission.  The nursing home patient was admitted to the facility for physical therapy and nursing care following a complete knee replacement surgery.

Despite the facilities knowledge that the man had limited mobility due to his recent surgery, the facility failed to mobilize the man and get him out of bed– and perform the physical therapy he was at the facility for in the first place.

In addition to the role the nursing home played in the the development of the patients decubitus ulcers (similarly called: pressure ulcers, pressure sores or decubitus ulcers), the lawsuit alleges that the facility exacerbated the severity of the wounds when they delayed obtaining medical treatment.  As a result of the severity of the decubitus ulcers, the dead skin needed to be removed surgically by a process known as surgical debridement.

The lawsuit specifically alleged the following negligent acts on the part of the nursing home resulted in the patients decubitus ulcers:

• Failing to notify a physician of the change in the man’s medical condition
• Failing to implement medical treatments ordered by the man’s physician
• Failing to note changes in the man’s medical condition in the man’s chart
• Failing to implement a decubitus ulcer prevention program

The lawsuit is pending in Madison County Circuit Court in Southern Illinois.

Rehabilitation Patients In Nursing Home

In our nursing home litigation practice, we see a significant number of cases where a rehab patient has developed a decubitus ulcer during a short-term admission to a nursing home.  The underlying reasons may be varied, but I suspect that because many rehab patients tend to be younger and have an outward appearance that they are healthy, staff in nursing homes may be less likely to encourage them to engage in activity.

Similarly, short-term stays may result in abbreviated or incomplete ‘care plans’ which set forth with specificity what facilities must do to prevent wounds from developing in the first place.  Clearly, by accepting a patient– even for a short term stay– nursing homes must take the necessary steps to ensure their well-being.  As we see in the above matter, when facilities ignore this obligation significant problems may result.

Related Bed Sore FAQ’s

Why is it common for nursing home and hospital patients to develop bed sores on their back?

Are bed sores on the heels common?

What is surgical debridement of bed sores?

Where can I learn more about the laws applicable to people who develop bed sores in nursing homes or hospitals?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Research study concludes pressure ulcers continue to plague patients during hospitalizations

In the past, pressure ulcers were primarily associated with poor nursing home care.  Times have changed.  Today, pressure ulcers acquired during a hospitalization are a growing problem.  In our medical negligence group, we continue to see clients who enter a hospital for acute care, only to wind up with an acquisition of a pressure ulcer during their hospitalization.

Hospitals, like nursing homes, should conduct an assessment of all new patients and determine who may be at risk for developing pressure sores and implement prevention techniques.  In the case of patients who may be in a hospital for an extended period, facilities should perform ongoing monitoring of skin integrity and change care as needed.

Unlike nursing homes or assisted living facilities that tend to care for patients over extended periods of time, hospital-care tends to be for shorter duration and focused more on the providing medical treatment as opposed to more generalized care.

Perhaps the hospital-based focus on providing acute care is the core reason why pressure ulcers acquired during a hospitalization have been increasing recently.  A study sponsored by the Agency for Healthcare Research and Quality (AHRQ), revealed the number of hospital patients who develop pressure ulcers during their hospitalization (also known as pressure sores, bed sores or decubitus ulcers) has increased by 63% since 1996.

The AHRQ study further calculated that the hospital stay for treatment of pressure ulcers was 13 days and cost $37,500.

While a number of factors may increase the likelihood that patients may develop pressure ulcers, the underlying mechanics of pressure ulcers is premised on the scenario of unrelieved pressure on areas of the body for extended periods.  When pressure goes unrelieved on the body, blood circulation to the area is reduced and the tissue in the area dies.

Elderly hospital patients are particularly susceptible to development of pressure ulcers because we tend to lose muscle mass as we age.  Similarly, older hospital patients tend to have limited mobility– increasing the chances they stay in one position for longer periods of time.

Although pressure ulcers can develop in any area of the body– including unlikely areas like the back of the head, ears and fingers; the majority of pressure ulcers develop over bony prominences of the body such as: buttocks, heels, ankles and back.

With attentive staff, the overwhelming number of hospital-based pressure ulcers are preventable.  Acknowledging that pressure ulcers are a real and potentially life threatening problem is the first step that hospitals need to take in order to reduce the incidence of pressure ulcers at their facilities.  Additionally, implementing well-accepted preventative techniques is critical.

Widely accepted pressure ulcer prevention includes:

• Use pressure relieving air mattresses
• Rotate patients positioning bed or wheelchairs every two hours
• Keep patients clean and dry
• Make sure patients are receiving proper nutrition and hydration

Hospital negligence

In order to determine if the negligence a hospital is responsible for the development of a pressure ulcer, it is important to gather all hospital records and take photos of the wounds.  In our medical negligence practice, we commonly see that poor communication amongst staff is a major culprit for hospital-acquired pressure ulcers.  The poor communication is frequently found in medical charts where physician orders are not documented and patient condition goes undocumented for extended periods.

Related Bed Sore FAQ’s

Why is it important to differentiate the type of facility where a bed sore developed?

What can hospitals do to reduce the rate of bed sores in their facilities?

After I become aware of a bed sore, should I photograph it?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

MS patient settles pressure sore lawsuit against home health agency for $600,000

A woman with multiple sclerosis (MS) who was reliant on a home health care agency for medical assistance settled a lawsuit against the City of Seattle and Millennia home health care agency for $600,000.  The basis for the lawsuit was that a home health agency employee was negligent when they failed to follow the medical protocols set forth in the woman’s ‘care plan’ that was uniquely tailored to her needs.  It was alleged that the home health agencies failure to follow the care plan resulted in the formation of the pressure sores (similarly called: pressure ulcers, decubitus ulcers or bed sores).

In addition to the home health agencies failure to prevent the pressure sores from developing, an employee of the agency failed notify managers at the agency of the wounds, thereby delaying medical treatment and exacerbating the severity of the wounds.  Due to the stage 4 pressure sores, the woman required admission to Providence Hospital in Washington for two months of wound care.

During the hospitalization, doctors performed two surgeries to treat the pressure sores that had progressed so far that an infection had developed and spread to the bone (osteomyelitis).  In addition to the osteomyelitis, the pressure sores were also infected with MRSA, a bacteria that is difficult to treat.

This sad incident demonstrates what can happen when staff at home health agencies, nursing homes and hospitals fail to follow ‘care plans’.  Care plans are uniquely developed programs that are developed by physicians and other medical professionals to address the needs of each patient.

Should a home care nurse agency ignore the protocols set forth in a care plan or fail to provide accurate feedback of the patients medical condition monitor they expose themselves to liability for a resulting injury.

Related Bed Sore FAQ’s:

How much money does it cost to pursue a claim or lawsuit for bed sores?

Are there limits on the financial recovery for a person who developed bed sores due to the negligence of a facility?

If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Lawsuit alleges nursing home neglect contributed to patient’s decubitus ulcers

A former resident of the Virgil Calvert Nursing and Rehabilitation Center filed a nursing home negligence lawsuit against the Illinois nursing home after she developed multiple decubitus ulcers during her admission.   The nursing home lawsuit alleges that decubitus ulcers she developed during her admission resulted in severe pain, disability and extensive medical expenses related to their treatment.

The nursing home lawsuit alleges that the Virgil Calvert violated provisions of the Nursing Home Care Act, an Illinois law that was created to protect nursing home patients. The lawsuit also alleges that the facility failed to administer proper medication and provide the resident with necessary treatment to prevent the development of the decubitus ulcers.

In addition to suing the actual nursing home itself, the lawsuit also names the facilities parent company, SW Management Company.  The lawsuit claims that SW Management was negligent when they failed to supervise and train their employees with respect to the prevention and treatment of decubitus ulcers. The suit similarly alleges that the management company was negligent when it failed to terminate nursing home employees who were repeatedly incompetent, careless and unable to follow the policies set forth by the facility.

Decubitus ulcers are a common problem facing nursing home residents.  Nursing homes have a duty to create and implement a care plan to address prevention of decubitus ulcers.  Careful adherence by the entire nursing home staff is essential to proper skin care.  For many nursing home residents, already in a weakened physical state, a small decubitus ulcer may quickly advance to a large wound in a matter of days if a facility fails to timely implement necessary medical treatment.

Related Bed Sore FAQ’s

What type of legal recourse does a person with bed sores have?

If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?

Why are physically disabled patients at risk for developing bed sores?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Use visits of loved ones in nursing homes for more than social interactions—conduct your own assessment.

Visits to a loved one in a nursing home can— and should be fun and enjoyable for both the patient at the visitors.   The social interaction and stimulation provided by nursing home visitors is crucial for patients’ emotional well-being and can be a welcome diversion to mundane living situations.

However, don’t forget to take a few moments during your visit to do your own mini-assessment of your loved ones physical condition and the condition of the overall facility as well.

Take a step back and use your common sense and reasoning and really look at how your loved one looks.  Take a look at their skin—is it pale and ashen?  Are they having difficulty opening their eyes?  Have they lost a significant amount of weight?

While some observations may not be cause for immediate alarm, others should be brought to the attention of the staff.  If you observe any indication of injury or abuse, these should be immediately brought to the attention of the staff.

In patients who are bed-bound, pull back the sheets peek under the robe.  Is everything clean?  Are their any dry or cracked areas of skin?  Is there any unpleasant smell?  Does everything look ok?

As we age, our sensory perception begins to decline and as a result many elderly simply lack the ability to perceive potential problems with their body—particularly in areas that may not be visible.

If you suspect something does not look right with your loved one — it probably isn’t.  In many situations an early diagnosis of medical conditions, such as pressure sores (also referred to as pressure ulcers, pressure sores or decubitus ulcers) can drastically help improve the chances for a complete recovery– and may actually be a life saving intervention down the road.

Similarly, with respect the facility itself, take a careful look at the patient’s room itself, but also the common areas such as the recreation room and cafeteria.  Is this a place that you would be comfortable living in?

If not, why?   If there are problems, specifically identify each problem and bring it to the attention of a supervisor.   Giving constructive criticisms to the staff alerts them to conditions, which may not be readily apparent to those at the facility on a daily basis and will help improve the living arrangements for all patients at the facility.

Remember, you’re not being a pest when bringing your observations to the attention of nursing home staff!  In caring for a friend or family member you, can and should be an advocate.  If you don’t look out for your loved one’s best interest, who will?

Related Bed Sore FAQ’s

What information should a facility document in individuals with bed sores?

What are the risk factors for developing bed sores?

Where are bed sores most likely to form?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Hispanic nursing home patients are more likely to suffer from pressure ulcers

Researchers at Brown University have concluded that nursing homes with a higher percentage of Hispanic residents have higher rates of pressure ulcers than similar facilities with a predominately Caucasian population.

The studies’ results were based on data sourced from the National Repository of the Minimum Data Set (MDS), a mandatory assessment of all nursing home patients, and surveys of all nursing home residents sourced at the Oscar Database System. The findings of the Brown University study are detailed in the Journal of the American Medical Association.

In addition the national databases, the Brown study analyzed data from all nursing home residents over 65-year-old living in: California, New Mexico, Texas, Arizona and Colorado.

Vincent Mor, Chair of the Department of Community Health and head of the Brown study, headed a similar study in 2007 when he confirmed that African American nursing home patients had higher rates of complications than their peers.  That study determined that the problems amongst the African American nursing home patients was the worst in the Midwest.

Read more about the results of this nursing home survey here.

Pressure Ulcers Are Not An Isolated Problem Facing Minorities

A bed sore (similarly referred to as: pressure sore, pressure ulcer or decubitus ulcer) is an area of skin that dies when pressure on the area goes unrelieved for an extended period of time.  Frequently found in disabled or bedridden patients (even in younger patients), the steady pressure against the skin cuts off the blood supply to that area– resulting in death of skin, muscle and tissue. If the wound progresses, the wound may ‘open’ exposing the underlying layers of muscle and– even bone.

The most common areas for pressure ulcers to form are on areas of the body where increased pressure is put on the body as a person lays down or where there is a limited amount of flesh covering the underlying bone.  Pressure ulcers are commonly found in the following areas:

• Elbow
• Heels
• Hips
• Ankles
• Shoulders
• Back
• Back of the head

Pressure ulcers are preventable in the overwhelming majority of situations.  The first step in pressure ulcer prevention is to complete an initial assessment of all new patients– and to re-assess patients on a regular basis.  After the medical facilities have determined which patients are at a heightened risk for developing bed sores, a customized care plan should be developed. Most care plans include: frequent rotation (every two hours) of patients to discourage sitting in one area for long periods, pressure relieving air mattresses and special enhanced nutrition diets.

Minorities In Nursing Homes

Communication barriers are a primary reason why we tend to see higher rates of pressure ulcers in nursing homes with large percentages of minority patients.  Nursing homes should take necessary efforts to hire bilingual staff to assist patients both in communicating their needs to the staff and advising doctors as the patients needs.  Simple breakdown in communication, can result in serious threats to patient safety or even episodes of patient injury.

My office has zealously represented people with diverse backgrounds including: Hispanics, Japanese, Chinese, Israeli, Vietnamese, Russian and Italian.  When it comes to representation of the injured, I believe in justice for all.

Read more about minorities in nursing homes here.

Related Bed Sore FAQ’s:

Has any research been done regarding the prevalence of bed sores in nursing homes?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

The development of decubitus ulcers during a hospitalization is not just dangerous for the patient, it is simply bad business

Decubitus ulcer treatment is a big business! An estimated $1.3 billion is spent every year on wound care in the United States. In the past, hospitals were able to recover much of the expense related to pressure ulcer treatment directly from Medicare — even if the wound developed during a hospitalization at their facility.

New governmental regulations will make these reimbursements a thing of the past when the Centers for Medicare & Medicaid Services (CMS) deems the pressure ulcer to be avoidable. The result of this new regulation is that facilities now have an incentive to prevent pressure ulcers from developing in patients at their facilities or the facility pays for the treatment out of their own pocket.

“Preventing and managing pressure ulcers takes a very aggressive approach–one that requires facility wide buy-in and multi-disciplinary involvement,’ says Heather Hettrick, PT, PhD, a director at American Medical Technologies Inc.

Under the new CMS guidelines, facilities should begin the process of re-educating staff on common bed sore prevention measures such as: using off-loading boots, application of ointments, dressing changes and proper techniques to rotating patients to prevent them from laying in one position for too long.

Some facilities such as Regency Hospital, a long-term care facility in Minneapolis, have already taken steps to make pressure ulcer prevention a priority.  Every suspicious area on residents skin is photographed on a regular basis to keep track of the wound over time and as it heals.   Wounds are also regularly checked for surface temperature and skin color – the early signs of skin impairment.

Some of the pressure ulcer preventative techniques used at Regency Hospital are basic and can easily be applied at other facilities.  For example , staff is instructed to use hourly rounds look for the ‘Three P’s'  positioning, pottying, and pain.

As a friendly reminder to staff and patients to re-position themselves, music is played every two hours to remind residents and staff they need to change positions.   Other basic—yet effective devices such as ‘turning wheel’s’ are used in each resident’s room to demonstrate to all caregivers what position to change the resident to next.  Would care nurse, Kathy Irons, says it best, “we take a very proactive approach where everyone is held accountable.”

Related Bed Sore FAQ’s:

Are hospital patients prone to develop bed sores?

What can hospitals do to reduce the rate of bed sores in their facilities?

How many hospital patients suffer from bed sores?

Why is it important to differentiate the type of facility where a bed sore developed?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

In order to prevent pressure sores, it is important to analyze the factors that make a person susceptible to developing them.

Unfortunately, many patients in nursing homes, hospitals and assisted living facilities will develop a bed sore (similarly called: pressure sore, pressure ulcer or decubitus ulcer) at some point during their admission. When it comes to bed sore prevention, the first order of business is to determine who is at risk for developing the condition and implement preventative measures. Studies have revealed that patients with one or more of the following conditions are at a heightened risk for developing bed sores compared with the general population.

However, when it comes to bed sore prevention, the first order of business is to determine who is at risk for developing the condition and implement preventative measures.  Studies have revealed that patients with one or more of the following conditions are at a heightened risk for developing bed sores compared with the general population:

Age: As we age our skin becomes thinner and we lose muscle mass.  The reduction in skin and muscle mass translates to less natural cushioning on the bony parts of our body— those areas particularly susceptible to bed sore development.  Poor nutrition is another culprit that can make older people more likely to develop bed sores than their peers.  Studies have shown that patients over 70 have the highest incidence of bed sores than any other demographic.

Living In A Nursing Home: Compared with patients in hospitals and other living situations, nursing home residents the higher rates of bed sores.  Statistically speaking, part of the reason that bed sores are more common in nursing home patients is due to the fact that many of the patients are in weakened condition.  Other reasons that nursing home patients remain more likely to develop bed sores include:

• Immobilization, such as people who are recovering from a hip fracture or who are in a coma.
• Lack of pain perception, a loss of sensation may be due to a spinal cord injuries or disease. An inability to perceive pain means the patient is not aware when they’re uncomfortable and need to change positions or that a bedsore is forming.
• Incontinence, the caustic nature of urine and feces makes the skin more susceptible to breakdown and speeds the development of bed sores.

Malnutrition: A poor diet does more than contribute to weight loss.  Inadequate intake of vital nutrients such as: protein, zinc and vitamin C can contribute to skin breakdown and also hinder the bodies ability to heal existing pressure sores. Compared with patients who have a healthy diet, patients suffering from malnutrition frequently experience recurrent pressure sores, more severe infections and slower healing wounds.

Diabetes: Diabetes and vascular disease affects blood circulation and consequently areas of the body may not receive adequate blood flow and nutrients, increasing the chance of damage to tissue.

Contractures: Frozen or contracted joints make movement to reduce pressure difficult and put added stress on the body resulting in increases in friction and shear forces—that can add to the development of pressure sores.

Smoking: In addition to higher incidence of pressure sores, smokers have more severe wounds and delayed healing due to the fact that nicotine impairs circulation and reduces the amount of oxygen in your blood. Patients who are life-long smokers are particularly slow to heal from wounds related to pressure ulcers.

Even after the risk factors for developing pressure sores is identified, nursing home staff must be vigilant with their prevention techniques in order to assure the highest quality of life for all patients.

Related Bed Sore FAQ’s:

Can malnutrition cause bed sores?

Why are physically disabled patients at risk for developing bed sores?

If a person has contractures, are they at an increased likelihood for developing bed sores?

Are the development of bed sores during a nursing home admission an indication of nursing home neglect?

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »

Are bedsores completely preventable? Extremely likely.

Despite the fact that most families are reliant upon medical facilities for the care of their loved ones, I’ve noticed a stigma surrounding the development of bedsores during an admission to a nursing home or hospital. Sure, there can be a sense of guilt when it comes to any illness affecting a loved one, but when families learn the relatively simple preventative measures that facilities can implement to prevent bedsores, they usually are angry and embarrassed— simply because they feel as though they could have prevented the development of the bedsores has they know the simple preventative techniques.

As was the case with a family I met with today, who’s mother recently died from sepsis after a month stay at a Chicago-area hospital. The family confided in me that their mother had a gaping hole on her buttocks at the time of her death that went unattended to by the hospital for weeks.

Bedsores have a reputation of being associated with the poor and unwanted.  Yet, in reality they are frequently found at many hospitals and skilled nursing facilities—even those with excellent reputations.  The toll bed sores take on patients and families crosses all backgrounds and ethnicities.

With proper nursing care, bed sores should be preventable.  In order to minimize the incidence of bed sores, nursing homes should do an assessment of each patient on their admission to their facility to determine which patients are at a heightened risk for developing this condition.

In order to reduce the incidence of bed sores amongst their patient’s nursing homes and hospitals need to develop a team approach to prevention.  A recent New York Times article discussed the team-oriented approach necessary to reduce the development of bed sores in nursing homes.

Perhaps the most telling part of bed sore prevention is that all staff should be aware of how to prevent bed sores and who is at risk for developing them.  Empowering all employees in a medical facility to take it upon them to prevent and take necessary interventional techniques is one of the most important factors to improving patient care.

Read more at Jonathan Rosenfeld's Nursing Home Abuse Blog »