Do you know what you need to know about bedsores (also called pressure ulcers)? If you have a parent or other loved one in any treatment facility and your loved one has an injury or illness that limits mobility, you need to know a good bit about bedsores. What is more, you need to check your loved one regularly for the beginning of bedsores and other indications of neglect.

We frequently encounter people who believe bedsores are not a big deal. They could not be more wrong. Bedsores can become very serious injuries requiring long treatment and healing time. They are also painful. Perhaps more important, bedsores are often the tip of an iceberg that demands immediate action. You, or your loved one, might be in a hospital, rehabilitation facility, hospital, or even at home. Regardless of the surroundings, many patients are at risk for bed sores, particularly those who are paralyzed or unable to move around easily.

Causes of Bedsores

Bedsores or “pressure ulcers” develop due to pressure on the skin that is sufficient to limit blood flow to the skin and to surrounding tissues. Typically, these are places where the skin and muscle are insufficient to provide a cushion.  There are three primary factors that play a part in the development of bedsores. These are:

1. Ongoing pressure. When the skin over bones is under ongoing pressure from the bed or wheelchair, the pressure may be sufficient to restrict blood flow through the capillaries. These capillaries provide the oxygen and nutrients required by the skin and other tissues. In time, if unrelieved, the skin cells are damaged by lack of oxygen and might die. The most common places for these bedsores to develop is over the spine, shoulder blades, hips, heels, elbows or tailbone.
2. Shear occurs when two surfaces (skin and bed, for example) move in opposite directions. When, for example, the patient moves or slides in the bed or wheelchair, the skin might not move as quickly as the underlying bone (due to pressure against the bone). The result is that damage can occur to blood vessels and other tissue. This creates increased susceptibility to damage from ongoing pressure.
3. Friction is simply the rubbing of two surfaces against each other. This is very common when people slide in a wheelchair seat or against the bed sheets. It can also result from movement when caregivers are moving patients, or helping them move. Friction is particularly harmful when the skin is moist. When friction weakens the skin or damages underlying blood vessels the skin becomes especially vulnerable to damage resulting from ongoing pressure.

Bedsore Stages

Bedsores are classified on a four-point scale determined by their severity. The National Pressure Ulcer Advisory Panel (devoted to the prevention and treatment of bedsores) defines the four points or stages this way:

1. Stage 1. In the first stage of bedsore development the skin is not broken. It will be red on people of lighter skin color and may show some discoloration of the skin of people of color. The important characteristic is that the skin does not blanch (temporarily lighten) when touched. The site of the developing bedsore is typically either warm or cool compared to the surrounding skin. It will also be firm and painful or tender.
2. Stage 2. In the second stage of development, the bedsore will show damage to or loss of the outer layer or two of skin. This wound will be discolored, but will be shallow. It may have the appearance of a blister that is filled with fluid or of a ruptured blister.
3. Stage 3. When the bedsore develops to the third stage it has become a deep wound. The skin loss probably exposes some fat. The sore looks much like a crater. The bottom of the crater may show some yellowish dead tissue. The damage may be deeper than it appear to be, possibly reaching deeper through the deep skin layers.
4. Stage 4. When the bedsore reaches the fourth stage, significant damage will be apparent, and might show muscle, bone, or tendons. The lowest area of the wound will contain dead tissue. This dead tissue will look much like a scab: yellow or dark and crusted. At this point, the damage from the sore extends deeply through the layers of skin.

Other Things You Need to Know

First, it should be understood that bedsores require treatment, particularly when they reach stage 3 or 4. Early stages of bedsores can typically be treated with medication dressing of the wounds. Severe sores often require debriding (tissue removal) or surgery.

Second, bedsores are subject to complications. Like other open wounds, bedsores are susceptible to cellulitis and bacterial infections that can quickly become septic. Untreated, sepsis can cause organ failure, shock, or even death.

Third, bedsores are preventable. Patients capable of only limited movement must be turned and repositioned regularly to ensure that no part of the body is subject to long-term pressure. It is also important that designated procedures be followed by caregivers to avoid causing friction or shear.

Finally, bedsores indicate negligence on the part of the caregiver or facility. They might be an indication of more serious abuse of patients. People who develop bedsores due to the negligence of their caregivers might be entitled to appropriate compensation.

If you or a loved one has developed bedsores and you believe the staff of a facility has been negligent or abusive, we hope you will call Altizer Law, P.C. We have a deep commitment to protecting our most vulnerable citizens.

Related content:

https://altizerlaw.com/areas-of-practice/nursing-home-neglect/

https://altizerlaw.com/nursing-home-neglect-protecting-loved-ones/