Bed Sore Fatalities
Pressure ulcers (bedsores, pressure sores, pressure wounds, decubitus ulcers) are preventable medically complicated wounds that claim innocent victims' lives every year.
According to CDC (Centers for Disease Control and Prevention), approximately thirty-three percent of all hospitalized patients that developed pressure wounds will die from the condition during hospitalization. Over fifty percent of hospital patients and nursing home residents developing decubitus wounds die within the next year.
Nearly eight percent of all individuals with paraplegia will die from pressure injuries due to the wound's ulceration. All told, about 60,000 individuals die every year from medical complications associated with pressure sores.
When Pressure Ulcers Cause Death
Ulcerated pressure wounds claim the lives of nursing home residents in hospitalized patients every day. When the decubitus ulcers are allowed to progress to Stage 3 and stage 4, the injured surface opens, exposing the bed sore to infection and bacteria.
If the bed sore is left untreated, a developing infection might lead to septic shock and sepsis (blood infection), followed by organ failure and preventable death. According to the Centers for Medicare and Medicaid Services (CMS), nearly every pressure sore is preventable if the medical team followed the established protocols in treating the sore.
Consistent treatment will involve proper nutrition, continuing hydration, and a rigorous regimen of offloading the patient's pressure on a body part to allow the pressure ulcer to heal. Encouraging blood flow and minimizing complications might avoid infections and death.
Death caused by infections might be from nursing home abuse or negligence. Staff members must follow doctor's orders when providing effective treatment, including monitoring the sore and implementing a routine turning and repositioning schedule.
Nursing Home Abuse
Negligence and abuse in nursing homes might lead to unnecessary pain, suffering, and wrongful death. The staff has no excuse for allowing pressure ulcers to develop when the patient receives care at the facility.
In nearly every case, a facility-acquired bed sore develops from patient neglect. Medicare regulators identify a developing decubitus ulcer as a "never event," meaning the sore should never occur.
A developing bed sore is never an acceptable part of nursing home care or hospitalization. Without treatment, a bed sore could result in osteomyelitis (bone infection), sepsis (blood infection), or other health problems, including wrongful death.
How a Pressure Ulcer Develops in a Nursing Home
Nearly all bedsores are the result of immobility and improper hygiene. The sore develops from restricted vascular circulation from pressure on a body part, including the head, back, buttocks, heels, shoulders, elbows, toes, and hips.
Alleviating the pressure allows oxygenated, nutrient-rich blood to reach the affected bed sore before skin tissue is damaged. Most at-risk nursing home residents require assistance to move in a wheelchair or bed.
The nursing team must follow a strict turning and repositioning regimen by moving the patient at least once every one to two hours. Offloading the pressure correlates directly to preventing bed sores. Any failure to do so could be the side of nursing home abuse and neglect.
State regulators follow federal law enacted to protect residents from the nursing staff's reckless behavior that might cause an avoidable sore. Bedsores that arise from health complications are still rampant throughout the nursing home industry and are typically the result of overworked nurses or understaffing.
Failing to ensure that the resident's needs are being met increases the potential of an immobile patient being left in their feces and urine, compromising skin integrity. Within one hour, the compromised skin can create an underlying infection and permanently damage the affected area.
Regular movement from a stationary position (a minimum of once every two hours) and keeping the skin clean and dry is the facility staff's responsibility. However, the Nursing Home Administrator or HR Department might fail to follow the best hiring practices or inadequately train their personnel on established care techniques.
Restricted Blood Flow and Skin Breakdown
According to the National Center for Biotechnology Information, "pressure ulcers are associated with fatal septic infections and are reported as a cause of thousands of deaths each year in the United States."
Typically, pressure ulcers result from skin breakdown when residents in nursing homes and hospitals remain stationary for too long without shifting their weight. Generally, bedsores occur in individuals who are temporarily or permanently bedridden or in wheelchairs.
A pressure ulcer first appears as reddened skin that can become progressively worse if left untreated. Over time, the area will form a blister followed by an open sore and eventually develop a deed crater.
In its initial stage, the injury might appear warm to the touch due to the restricted vascular circulation. Alleviating the pressure can minimize damage and initiate the healing process.
If the wound is allowed to worsen, a severe infection might develop in as little as a few hours or days. Over time, a degrading wound might be susceptible to infections, dead tissue, and eventually death.
The most affected areas susceptible to restricted vascular circulation include the back of the head, back, shoulders, ankles, hips, sacrum (tailbone), heels, and elbows.
Pressure Wound Risk Factors
The nursing home caregiving team developing an effective care Plan will assess the patient's risk for developing pressure ulcers.
Some of these factors include:
- Permanent or temporary use of a wheelchair
- Being bedridden
- Malnourishment or dehydration
- Fragile skin
- Chronic conditions, including vascular disease and diabetes that restricts proper vascular circulation
- Older age
- Mobility-challenged patients requiring assistance to move, including those with multiple sclerosis or other neuromuscular diseases
- Patients with paraplegia, quadriplegia, brain injury, or spinal damage
- Nursing home residents with bowel incontinence or urinary incontinence
- Patients with cognitive disabilities, including memory loss, Alzheimer's disease, or dementia
Most of the conditions listed above are common problems in nursing homes that require the nursing staff to follow established bedsore prevention protocols.
Staging a Pressure Ulcer
Medical science categorizes (stages) bed sores based on the extent of skin damage, the depth of the crater, and the severity of the sore. A Stage 1 (least severe) bedsore is easily treated compared to a Stage 4 (most severe), leading to most bedsore fatalities.
A newly developing Stage 1 bedsore affects the outer upper skin layer (epidermis) with typical symptoms, including itching, burning, and pain. Generally, the skin feels warm to the touch and might be softer or firmer than the surrounding area.
Bed sores are less detectable in patients with darker skin tones. The restricted vascular circulation to the skin is usually detected when pressing the spot that does not become lighter in appearance.
The healing process usually takes 2 to 3 days and requires washing the developing sore using mild soap and water before gently driving the skin. The patient should consume a specialized diet rich and protein, minerals, and vitamins A & C.
Stage 2 Decubitus Ulcers
If the wound is allowed to progress, the skin can quickly degrade to a Stage 2 pressure sore, breaking skin tissue and leaving an open wound. The pressure ulcer might appear as a post-field blister that is read, warm, and swollen, oozing pus or clear fluid.
The healing process lasts up to three weeks and requires a saline water solution to clean the area and gently dry the skin. Typically, the patient experiences significant discomfort from injuries requiring a pain reliever before treatment.
The nursing staff must cover the open sore using moist gauze or see-through dressing. Any noticeable signs of infection (redness, fever, or pus) require a doctor's attention.
Stage 3 Pressure Ulcers
Advancing bedsores reaching Stage 3 affect the skin's deep fatty tissue layers appearing as a deep crater with a foul odor. Usually, there are indicators of infection, including a strong odor, the presence of pus, red edges, heat, and fluid/pus drainage.
Dead tissue injuries might appear as a blackened area. The extensive Stage 3 healing process usually requires removing necrotic (dead) tissue to promote new skin growth and the intake of prescribed antibiotics to treat the infection.
The patient might require the use of a particular pressure-relieving mattress or bed.
Stage 4 Pressure Sores
The most advanced stage of a degrading pressure ulcer might be life-threatening, exposing ligaments, tendons, bone, and muscle tissue. At this stage, the pressure ulcer is large and deep, with blackened areas showing signs of infection, including heat, foul odor, pus, red edges, and pus/ fluid drainage.
A stage IV, life-threatening pressure ulcer requires immediate attention, including surgical procedures. Healing, when possible, takes months or years. Thousands of patients die every year from bedsore fatalities involving Stage 4 fatal decubitus ulcers.
Unstageable Pressure Sores
Some bedsores are unstageable when the presence of eschar, slough, or necrotic tissue blocks the view of the wound's depth, width, and severity. However, cleaning out the ulcer can provide a better opportunity to stage the sore so the damage can be determined.
Suspected Deep Tissue Injury (SDTI)
Sometimes, doctors or wound care specialists will diagnose the patient's bedsore as a Stage 1 or Stage 2 because of its appearance on the skin surface. However, there might be suspected deep tissue injury underneath a minor pressure sore, hiding a Stage 3 or 4 decubitus ulcers.
Preventing Bed Sore Deaths
For decades, the healthcare industry has optimized nursing procedures and protocols that effectively prevent developing pressure ulcers. Doctors and nurses assess hospital and nursing home patients known to be at risk of developing decubitus ulcers at all stages.
The caregiving team creates a proper care plan that includes:
- Frequently rotating or adjusting the patient's lying or sitting position
- Offloading pressure points using pressure-relieving air mattresses
- Assessing the resident's skin to identify any compromised area developing a sore
Fatal Bed Sores FAQs
Can a Pressure Sore Kill You?
Many bedsore fatalities result from a lack of proper treatment when dead tissue creates an open crater exposing muscle tissue and bone. The patient dies due to an infection that might involve osteomyelitis (bone infection) or sepsis (blood infection).
What Causes Bed Sores in Nursing Homes?
According to Medicare regulators, bedsores at all stages are preventable if the nursing staff follows the established protocols. A facility-acquired pressure ulcer is often a sign of nursing home abuse or neglect when staff members fail to follow the residents' care plans.
Can You Die from an Infected Pressure Sore?
Without immediate attention and treatment, residents might die quickly from advanced infected pressure ulcers. In some cases, health complications might compromise residents at high risk for developing pressure ulcers and infections.
However, the wound care team might ensure that the residents receive treatment before their wounds advance to a fatal stage.
What Does a Stage 1 Pressure Sore Look Like?
A newly forming pressure sore appears red and warm to the touch in its initial stage, caused by restricted vascular circulation. Typically, the sore is the body's response to pressure on at-risk areas, including the back, back of the head, elbows, tailbone (sacrum), hip bones, back of the knees, heels, ankles, and toes.
Why do Bed Sores Smell So Bad?
The pressure sore's malodor (foul smell) might be from bacterial colonization (accumulated pus), necrosis (dead tissue), or exposed muscle and bone. A chemical reaction from using hydrocolloids might also cause a foul odor when medicines are placed between the ulcer exudate and dressing.
Outlook for Patients With Advanced Bed Sores
Family members learning that a loved one developed pressure ulcers need to act quickly. The steps you take after suspecting bedsores might mean the difference between your loved one's life or death.
Notify the Director of Nursing, Medical Director, and Administrator of the neglect to ensure that the loved one receives immediate attention. Bringing in an outside wound care specialist might be necessary for treating the injuries to ensure the patient's safety and well-being.
Never leave documenting the sore to the caregiving team to ensure there is evidence of what occurred. Take photographs and list the names of every doctor and nurse you have spoken with about your loved one's wound.
Follow-up is crucial to ensure that the injured victim uses pressure-alleviating devices to remove pressure from the affected area. The ulcer must be treated with special dressings and medicated gauze.
The nursing staff should ensure that the victim receives good nutrition. The wound care specialist or surgeon should remove any infected, damage, or dead tissue through debridement (cutting away) to allow healthy skin to grow.
Turning and positioning a mobility-challenged resident is vital to their ongoing well-being during the healing process to prevent deaths.