Pressure ulcers occur when pressure causes damage to the skin. There are 3 main risk factors to developing a pressure ulcer: immobility, increased pressure skin, and an interruption of the blood flow.
Many nursing homes and assisted facilities will tell you that a bed sore is unavoidable. But here’s what the law says:
Nursing homes “must ensure” that:
(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and
(2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.
42 CFR § 483.25(c)
The guidelines define “unavoidable” to mean that the resident “developed a pressure ulcer even though the facility had evaluated the resident’s clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with resident needs, goals and recognized standards or practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate.”
The residents facility must show that they have (1) assessed the resident (2) developed an appropriate plan to prevent skin breakdown; (3) implemented the plan; and (4) revised the plan as conditions changed
Even if your loved one had every single risk factor making them highly susceptible to pressure ulcers, the facility must still follow the above law by performing adequate assessments of risk and implement a working plan to prevent or heal breaks in the skin. Only then is any bed sore legally defined as “unavoidable.” Almost all the cases that come across my desk fail to follow the state and federal regulations, thereby making their loved ones bed sore totally preventable.
Further, without proper care, any break in the skin can become infected. Common infections related to pressure ulcers include localized infection cellulitis and osteomyelitis. These and other infections can all lead to sepsis which is a life threatening medical emergency.
Sepsis is the body’s response to infection. Like any other major health related event, sepsis is a medical emergency that requires rapid diagnosis and treatment.
Any pressure sore where the skin has broken is susceptible to infection, but the risk is higher when the sore is located around the tailbone or buttocks. Incontinent residents are among the highest risk patients because both urine and stool are very abrasive to delicate skin. Once there is any wound or tear in the skin, the constant moisture or irritation increases the risk of infection. The elderly who are at highest risk for bed sores need to have an effective plan to ensure infection does not develop.
If the skin has broken, it’s vital to watch for signs of infection:
- A foul smell
- Increasing redness or darkening around the wound
- Increasing pain or discomfort
- Confusion or disorientation
- Fever (or decreased body temperature in the elderly)
If there is an infection, it will likely need to be treated with antibiotics and extra care to clean and dress the sore. If not addressed swiftly, sepsis can develop.
When it comes to sepsis, remember it’s all about TIME. If any of these symptoms develop, it’s critical a doctor is called right away.
T: Temperature. In the elderly any abnormal temperature needs prompt attention. Whether higher or lower than the patients previous or normal result.
I: Infection: Any signs or symptoms of infection such as pus, swelling, red or black coloring at the site.
M: Mental Decline: Confusion, sleepiness, difficult to rouse
E: Extremely Ill: Severe pain, shortness of breath, discomfort
If your loved one developed an infection related bed sore, we want you to remember what the law defines as unavoidable when assessing facilities for fault when a resident develops a pressure ulcer.