• Unrelieved pressure on the body
• Malnutrition
• Dehydration
• Staff failing to keep patients clean and dry

However, many relatively healthy and young people who enter skilled nursing facilities or designated rehab centers develop bed sores due an injury which may immobilize them and keep them confined to a bed or wheelchair for extended periods.  Staff in rehab facilities must be aware that rehab patients are indeed at risk for developing bed sores and should be diligent with their preventional programs.

Similarly, staff in rehab facilities must be aware that even relatively young patients are at an increased risk for developing bed sores particularly when they are immobilized from medical conditions such:

• Joint replacements
• Hip fractures
• Pelvis fractures
• Leg fractures
• Paralysis
• Coma

Related:

Lawsuit Claims That Nursing Home’s Negligence Resulted In Patient’s Decubitus Ulcers

In For Rehab. Out With Bedsores.

Many patients with bed sores (similarly referred to as: pressure sores, pressure ulcers or decubitus ulcers) suffer additional harm when the staff responsible for caring for them fails to follow medical orders with respect to the frequency with which dressings are to be changed.  If dressings are not changed according to orders set forth by a physician, the healing of the bed sores may be delayed — and perhaps become infected.

The most commonly used dressings used to treat bed sores include:

Absorptive Dressings: These dressings are either applied directly to the wound or on top of other primary dressings. Absorptive dressings are intended to remove the drainage from the bed sore that may impede healing.  Most absorptive dressings are changed on a daily basis.  However, excessive drainage from a bed sore may require more frequent dressing changes.

Common types of Absorptive dressings include: Medipore, Silon Dual Dress, Aquacel Hyrofiber Combiderm, Absorbtive Border, Multipad Soforb, Iodoflex, Tielle, Telefamax, Tendersorb, Mepore and Exu-dry.

Alginates: Alginates are dressings made from fibers either completely or partially made from seaweed or algae. Alginates absorb drainage from a bed sore and form a gel-type barrier over the wound that ensures a moist environment to assist in healing wounds.  Alginates are commonly used in treating deep bed sores as they allow wounds to heal even with dressings in the wound.

Common types of Alginates include: Algicell, Algisite, Carrasorb, Curasorb, Dermacea, Dermaginate, fybron, Gentell, Kaltostat, Kalginate, Maxorb, Silvercell, Sorbsan, Seasorb, Tegagen

Antimocrobials: In wound care, antimocribials refer to dressings that contain antibacterial products or antibacterial creams used to reduce or kill bacteria in bed sores.  Before using antimocrobials, a physician must first determine the if the bed sore is infected.  A bed sore can be tested for infection by doing a culture. In some circumstances where a patient may be particularly at risk for developing an infection, a physician may prescribe antimocrobials as a preventative measure.

Common types of Antimicrobials include: Tegaderm, Amerigel, Anasept, Silverton, Contreet, Aquacel, Silverderm, Algidex, Colactive, Kerlix, Tefla, Arglase, Maxorb, Optifoam, Acticoat,

Hydrocolloids / Hydrogels: Hydrocolloid dressings have gel-like properties and absorb fluids from the wound.  Because hydrocolloid dressings form a moisture-proof barrier they frequently used with incontinent patients as they can keep urine and feces out of the healing wounds.  Hydrocolloids should be used in un-infected bed sores.  A physician should determine the frequency with which a hydrogel dressing should be changed.  Generally hydrogel dressings are changed from 2 to 7 times per week.

Common types of Hydrocolloid / Hydrogel dressings include: Tegagel, Biolex, Carrasorb, Purilon, Repair Hydrogel, Dermasyn, Dermagran, Curasol, Restore, Nu-gel, Curafil, Skintegrity, Panoplex

Source: Wound Care Information Network

Understandably, many elderly are drawn to these nursing-home-alternative facilities because they may provide increased independence and because they provide an alternative to the generic qualities associated with large nursing homes.

Unfortunately, many of the assisted living facilities, group homes and adult day care facilities are not intended to provide the skilled nursing and medical care, some of their patients clearly require. Similarly, the extensive federal and state regulations that apply to nursing homes do not apply to this ‘new’ group of care facilities.

Nonetheless, there is an implicit agreement on the part assisted living facilities (along with group homes and adult day care centers) that when they agree to care for their patients, they are agreeing to take necessary steps to prevent their patients from harm and the development of bed sores.

Should a resident of an assisted living facility develop a bed sore (or similarly referred to as: pressure ulcer, pressure sore or decubitus ulcer) during an admission, the facility should obtain medical attention for the person immediately and / or have them transferred to a more appropriate type of medical facility immediately.

When a person develops bed sores during an admission to an assisted living facility, they may be entitled to pursue cause of action due to the facilities negligence.

Most lawyers who concentrate in medical malpractice or nursing home litigation will evaluate the merits of the case for no charge to you.  If an investigation reveals the medical facilities conduct resulted in the development of bed sores (also called decubitus ulcers, pressure sore or pressure ulcer), most attorneys will agree to pursue the matter on contingency fee arrangement.

Under a contingency fee arrangement, a lawyer receives payment for his or her services when they recover money for the injured person or their family.  Most contingency fee arrangements, provide that the attorney will not receive any payment until the case is tried to verdict or settled.

The percentage of the recovery a lawyer charges is dependent on the type of case and the complexity of the matter.  Nonetheless, the exact percentage should be agreed upon in writing soon after the lawyer has been retained.

Most contingency fee arrangements also specify who is to be responsible for the expenses relating to the prosecution of the matter (court fees, expenses related to procuring medical records, physician record review, deposition fees ect.).  Depending on the circumstances of each case, the cases expenses may be advanced by the lawyer, the client or a combination of both.  In all cases, the arrangement should be set forth in writing as soon as reasonable.

Sepsis

Sepsis is a bacterial infection in the bloodstream or body tissues, frequently found in patients with severe bed sores (similarly called: decubitus ulcers, pressure ulcers or pressure sores).  Some patients with sepsis experience a complete inflammation of their body due to infection of blood.   If a person does not respond to medical treatment, they may go into septic shock which can result in organ failure and extreme low blood pressure (hypotension) or decreased blood flow (hypoperfusion).  The mortality rate for patients with sepsis is 20% to 40%.

Meningitis

Meningitis is an infection in the membrane and fluid surrounding the brain and spinal cord.  There are two general types of meningitis– viral meningitis and bacterial meningitis.  In order to determine what type of meningitis a person has, a physician must sample the spinal fluid and perform a culture.  Determining the strain of meningitis will determine the type of treatment.

Because of the risk of severe medical complications with cellulitis, it is important for medical facilities to promptly make an accurate diagnosis of the cellulitis (usually with a blood test) and to administer antibiotics.

Over time, the bodies a delayed pain response results in changes to the sympathetic portion of the Autonomic Nervous System (helps people adapt to changes in the environment and is associated with the “flight-or-fight” response), resulting in muscle spasms and a narrowing of the blood vessels. This in turn can cause blood pressure to rise and heart rate to drop, which can lead to stroke, seizure, or even death.

Signs autonomic dysreflexia may include:

• Pounding headache
• Goose bumps
• Red blotches on the skin, above the level of the spinal cord injury
• Sweating, above the level of injury
• Cold, clammy skin, below the injury
• Nasal congestion
• Slow pulse (< 60 beats/minute)
• Hypertension (blood pressure greater than 200/100)

Autonomic Dysreflexia can be prevented. Specific precautions include:

• Frequent pressure relief in bed / chair (turning the patient to change positions) to prevent bed sores
• Proper nutrition and fluid intake
• Compliance with medications
• Perform routine skin assessments to prevent development of bed sores

Treatment of autonomic dysreflexia can be as easy as changing positions or removing the cause of irritation. However, treatment must be initiated quickly in order to prevent further complications. Many stimuli can cause autonomic dysreflexia including anything that would have been painful, uncomfortable, or physically irritating before the injury.

In addition to bed sores, the most common causes of Autonomic Dysreflexia are:

• Overfilled bladder – this can be due to a blockage in urinary drainage device, bladder infection, inadequate bladder emptying, bladder spasms, or bladder stones
• Bowel full of stool or gas – due to constipation, hemorrhoids, anal fissures, infection or impacted bowel
• Skin irritations – aside from bed sores including: ingrown toenails, burns, or tight / restrictive clothing
• Broken bones

If the trigger cannot be identified and removed or if problems persist, medications can be used to treat the autonomic dysreflexia.  As with many medical complications related to bed sores, the limited benefits of some medical treatments, stress the need to prevent the condition from developing in the first place.  Because spinal cord injuries can reduce or eliminate sensations, many spinal cord injury patients are unaware that a pressure sore is developing on their body. Nonetheless, because people suffering from spinal cord injuries are particularly susceptible to bed sores (also called pressure sores, decubitus ulcers or pressure ulcers) they are the most likely group to develop autonomic dysrelexia.

Autonomic dysreflexia must be recognized by medical professionals for the serious condition it is.   Autonomic dysreflexia is potentially life threatening condition resulting from over activity in the Autonomic Nervous System, which leads to high blood pressure leading to seizures, stroke, and even death.

Related:

The Failure To Treat Pain In Paralyzed Patients With Decubitus Ulcers Can Result In Autonomic Dysreflexia

Should a bed sore (also referred to as: decubitus ulcer, pressure ulcer or pressure sore) form in a cast that has a surgical wound, there is a heightened risk for infection and possibly osteomyelitis.

In certain situations involving patients who have developed bed sores under their cast, the cast itself may have been applied improperly.  In these situations, a cause of action may possibly be brought against the physician or medical facility where the cast was initially applied.

A physician generally determines how frequently a bed sore should be measured and re-assesed on a formal basis.  Nonetheless, staff should note any rapid deterioration or unusual changes and bring the changes to the attention of a treating physician if warranted.

The healing time for a bed sore depends on the size and severity of the wound(s).  For example, a stage 1 bed sore may heal within a few days while a stage 4 bed sore may take several months or more. Patients suffering from severe bed sores may require years of medical treatment.  Unfortunately, some bed sores may never heal– especially when the person has other illnesses or is elderly.  There are no specific guidelines that can be used to predict whether an ulcer will be “non-healing.”

The level of functioning dictates the necessary care.  While a patient suffering from a traumatic brain injury may require a great deal of assistance with their daily living needs, a dementia patient may simply need reminders or re-direction from staff to help.

Staff in nursing homes, hospitals and assisted living facilities must get to know their patients to provide them with the level of care they require.  In any respect, mentally disabled patients should be encouraged to be as active as feasible.  When patients remain bed-bound and inactive their risk for developing bed sores (also referred to as: decubitus ulcer, pressure ulcer and pressure sore) increases significantly.

In addition to encouraging activity, in order to prevent bed sores in mentally handicapped patients, extra care should be given during meals (to encourage them to eat properly) and by listening to any complaints made by the person.