Introduction
Pressure sores are potentially life-threatening injuries which too often develop in nursing homes. Pressure sores are not inevitable and can be prevented with diligence. In order to prevent pressure sores, nursing homes must identify a patient’s risk factors and develop and implement an appropriate plan of care that includes necessary interventions to ensure that a patient is properly protected. Unfortunately, inadequate attention is given by the nursing home staff to fulfilling these responsibilities. The fact that pressure sores are common in nursing homes does not mean they should be common in nursing homes. To be clear, pressure sores are preventable injuries and should not be common in nursing homes. Below we will discuss why pressure sores are too prevalent in nursing homes and what you can do to help.
About Pressure Sores
A commonly used definition of pressure sore is: any lesion caused by unrelieved pressure that results in damage to the underlying tissue(s). A pressure sore is a localized area of tissue injury that develops when soft tissue is compressed between a bony prominence (any point on the body where the bone is immediately below the skin surface) and an external surface for a prolonged period of time. The external surface may be a mattress, a chair or wheelchair, a medical device (such as a boot, brace, etc.), or even other parts of the body. Pressure sores can become a very serious problem, leading to significant pain, extended hospital or nursing home stays, and prolonged recovery periods from other health problems. And as with all serious health problems, prevention is of utmost importance.
The Prevalence of Pressure Sores in Nursing Homes
Pressure sores have long been established as an indicator of substandard care. In 2008, Centers for Medicare and Medicaid Services in fact included Stages III or IV pressure sores as a “never event”. A never event refers to a preventable medical error or adverse event that should never occur in any healthcare setting. These events are serious, often life-threatening, and represent a breach of patient safety protocols and standards. Pressure sores, also known as pressure ulcers or bedsores, are considered a never event because they are preventable with appropriate care and interventions. The inclusion of pressure sores in the category of never events highlights their severe impact on patient well-being and underscores the importance of diligent preventive measures in healthcare facilities. The occurrence of pressure sores can be indicative of inadequate patient care, negligence, or substandard practices, emphasizing the need for healthcare providers to prioritize patient safety and implement measures to prevent the development of pressure sores in vulnerable patients, particularly those in nursing homes or with limited mobility.
Despite being classified as a “never event”, pressure sores remain a widespread problem in long-term care facilities. Studies have found that up to 28% of the nursing home population may suffer from pressure sores. (NCHS, Park-Lee & Caffrey, 2004). Further, evidence suggests that the problem may be growing worse. The number of pressure-sore-related hospital stays increased 27.2% from 1993 to 2006, a rate that outpaces the increase in hospitalizations for all causes during the same period (Russo et al, 2008).
Why Pressure Sores Develop in Nursing Homes
There are a number of reasons why pressure sores are too often allowed to develop in nursing homes. Each of these reasons is avoidable with proper planning and diligence.
Failure To Ensure Proper and Timely Repositioning
Nursing homes must ensure that patients who need assistance with turning and repositioning receive timely and diligent assistance. When a patient remains in the same position for prolonged periods without adequate changes or repositioning, the continuous pressure on certain body parts restricts blood flow to those regions. The lack of proper blood circulation deprives the skin and underlying tissues of essential oxygen and nutrients, leading to tissue damage and skin breakdown. The failure to ensure proper repositioning of a nursing home patient foreseeably leads to the development of pressure sores due to the sustained pressure on specific areas of the body. Areas such as the heels, hips, tailbone, and back are particularly susceptible to pressure sores. Negligence in repositioning the patient and relieving pressure points can cause these painful and potentially serious wounds to develop rapidly and needlessly.
Improper Repositioning Technique
When repositioning is not done with the appropriate technique or when an insufficient number of staff members are involved, it can result in harmful forces being exerted on the patient’s skin. Friction occurs when the patient’s skin rubs against the bedding or clothing during movement. Improper techniques, such as dragging rather than lifting the patient, can significantly increase friction, increasing the risk of skin damage. Shear forces, on the other hand, happen when the skin layers slide against each other, putting strain on the blood vessels and tissues underneath the skin. If repositioning is not carefully executed, the patient’s body may shift, causing shear between the skin and the underlying bone or muscle. This can lead to microtears in the skin and blood vessels, further compromising blood flow and contributing to pressure sore formation. Proper repositioning techniques and an adequate number of staff members are crucial to minimize friction and shear forces, ensuring the patient’s skin remains intact and reducing the risk of pressure sore development in nursing home residents.
The Failure To Ensure Proper Nutrition and Hydration
The failure by a nursing home to ensure proper nutrition and hydration can significantly contribute to the development of pressure sores in residents. Adequate nutrition and hydration are crucial for maintaining healthy skin and promoting tissue repair. When nursing home residents do not receive the necessary nutrients and fluids, their skin becomes more susceptible to damage and less capable of withstanding pressure and friction. Malnutrition can lead to a decrease in collagen production, reducing the skin’s elasticity and resilience. Dehydration can result in dry, fragile skin, making it more prone to breakdown. Additionally, without sufficient hydration, the body’s ability to transport nutrients and oxygen to the skin is impaired, slowing down the healing process and exacerbating the effects of pressure on vulnerable areas. Proper nutrition and hydration are essential components of pressure sore prevention, emphasizing the need for nursing homes to prioritize residents’ dietary needs to minimize the risk of these painful and preventable wounds.
Improper Application of Medical Devices
The improper application of medical devices, including splints, boots, and compression stockings or TED hose, can contribute to the development of pressure sores in patients. These devices serve essential therapeutic purposes, but if they are not correctly fitted or adequately monitored, they can exert excessive pressure on specific areas of the body. In the case of compression stockings or TED hose, their intended purpose is to improve blood circulation and prevent deep vein thrombosis (DVT) in immobile patients. However, when these garments are not properly sized or positioned, they may constrict blood flow and create pressure points, particularly on the lower limbs. This sustained pressure can compromise skin integrity, leading to tissue damage and pressure sore formation. It is crucial for healthcare professionals to ensure appropriate fitting and continuous monitoring of these medical devices to prevent potential complications and provide optimal care for patients in need of such support.
Positioning A Patient On Tubing, Device, or Bed Hardware
In some instances, due to a lack of diligence, patients may be placed on medical equipment, tubing, or objects that create localized pressure on vulnerable areas of their body. Additionally, when a patient’s limb remains in contact with a bed rail or footboard for an extended period, it can lead to pressure on specific points, compromising blood flow to the affected regions and resulting in tissue damage and pressure sore formation. Proper patient positioning and regular checks to ensure patients are not lying or sitting on items that could cause pressure sores are vital preventive measures that nursing homes must implement to safeguard the well-being and comfort of their residents.
Failing to Ensure Proper Skin Inspections
Regular and thorough skin assessments are essential to identify early signs of potential skin breakdown. If these early indicators of undue pressure are noted, the care plan can be modified to include interventions that ensure that pressure is relieved to the affected area so that it can heal. When nursing home staff fail to conduct regular skin inspections, they miss the early warning signs of pressure sores. Additionally, without diligent skin inspections, nursing home staff will be unable to detect significant changes in existing pressure sores, leading to delayed treatment and potential complications.
Failing to Ensure Proper Heel Offloading
Failing to ensure proper heel offloading can significantly contribute to the development of pressure sores in nursing homes. Heel offloading is a crucial preventive measure to reduce pressure on the heels, a common site for pressure sore formation. When nursing home residents spend prolonged periods in a seated or lying position without offloading their heels, continuous pressure can lead to reduced blood flow and tissue ischemia in the area. The lack of relief from pressure prevents adequate oxygen and nutrient supply to the skin and underlying tissues, making the heels more susceptible to damage and pressure sore development. Implementing regular heel offloading techniques, such as elevating the heels off the bed surface or using specialized cushions, is essential in protecting vulnerable residents from the risk of pressure sores and promoting optimal skin health in nursing home settings.
Understaffing
Last, but not least, it is important to know that understaffing in a nursing home inevitably leads to a cascade of care failures, ultimately contributing to patients developing pressure sores. Adequate staffing is crucial for to avoid the care failures discussed above. Sufficient numbers of properly trained staff are necessary to ensure proper and regular repositioning of patients, proper monitoring and skin inspections, proper device application and monitoring, adequate nutrition and hydration, and so on. In the end, the root cause of nursing home patients developing pressure sores comes down to the facility’s failure to ensure adequate staffing to meet the residents needs.
What You Can Do
You should keep an eye out for any signs of a pressure sore, especially on or around a bony prominence. In addition, you can look for other signs of neglect or abuse. If you see any signs of neglect or abuse, you can report any suspect abuse or neglect by a nursing home to the proper authorities.
Conclusion
In conclusion, pressure sores remain a distressing and avoidable issue in nursing homes, posing significant risks to residents’ health and well-being. The prevalence of pressure sores in these facilities can be attributed to various care failures, including improper repositioning, inadequate nutrition and hydration, improper application of medical devices, and insufficient skin inspections. Moreover, positioning patients on tubing or bed hardware and failing to ensure proper heel offloading further contribute to the development of pressure sores. Understaffing is a critical factor that compounds these care failures, highlighting the need for sufficient and properly trained staff to meet residents’ needs. To address this pressing concern, nursing homes must prioritize patient safety, implement preventive measures, and ensure diligent care practices. By fostering a culture of attentiveness and accountability, nursing homes can significantly reduce the incidence of pressure sores, thereby improving the overall quality of care and enhancing the well-being of their residents.
Frequently Asked Questions (FAQs):
Q: What are pressure sores, and why do they develop in nursing homes?
A: Pressure sores, also known as pressure ulcers or bedsores, are localized areas of tissue injury that occur when soft tissues are compressed between a bony prominence and an external surface for an extended period. In nursing homes, pressure sores develop due to various care failures, including improper repositioning, inadequate nutrition, and hydration, and improper use of medical devices, among others.
Q: How prevalent are pressure sores in nursing homes?
A: Studies have concluded that pressure sores may affect up to 28% of the nursing home population. Additionally, the number of pressure-sore-related hospital stays has shown an alarming increase, outpacing the rise in hospitalizations for all causes during the same period.
Q: Why ae pressure sores considered a “never event” in healthcare settings?
A: Pressure sores are classified as a “never event” by the Centers for Medicare and Medicaid Services, signifying preventable medical errors or adverse events that should never occur. Their inclusion in this category highlights the severe impact on patient well-being and underscores the need for diligent preventive measures in healthcare facilities, including nursing homes.
Q: How does understaffing contribute to pressure sore development in nursing homes?
A: Understaffing in nursing homes leads to a cascade of care failures, ultimately contributing to patients developing pressure sores. Insufficient numbers of properly trained staff result in inadequate repositioning, monitoring, and skin inspections, as well as improper application of medical devices, poor nutrition, and insufficient heel offloading.
Q: What can nursing homes do to prevent pressure sores among their residents?
A: To prevent pressure sores, nursing homes must prioritize patient safety and implement preventive measures. This includes proper repositioning techniques, ensuring adequate nutrition and hydration, using medical devices correctly, conducting regular skin inspections, and ensuring proper heel offloading. Additionally, addressing understaffing is crucial to providing comprehensive care and reducing the incidence of pressure sores in nursing home residents.
Jeff Powless is an attorney and the author of the 2017 book, Abuses and Excuses: How To Hold Bad Nursing Homes Accountable. Abuses and Excuses breaks new ground in helping patients and families hold bad nursing homes accountable, sharing a wealth of insider strategies and insights. It’s an eye-opening account of corporate greed, acts of neglect and abuse, an insidious industry culture of cover-up, and the actual harm that inevitably befalls vulnerable nursing home patients all across the country with shocking frequency.