Health Care Facility Acquired Bedsores Should the Facility Provide Restorative Care or Palliative Care
Some patients in hospitals and residents in nursing homes are highly susceptible to developing bedsores (pressure sores, pressure wounds, decubitus ulcers, or pressure ulcers). In a recent study by the National Pressure Ulcer Advisory Panel, there are many contributing factors related to developing bedsores; especially for those with limited mobility and the need for assistance when repositioning. Even individuals with healthy skin may suffer serious health problems when receiving substandard care. If the patient develops a pressure wound while in a healthcare facility, who is responsible for providing restorative or palliative care?
Rosenfeld Injury Lawyers LLC represents victims of mistreatment, abuse, and other types of professional negligence. Our law firm has successfully prosecuted cases for our clients who developed life-threatening bedsores that could have been avoided had the medical team provided preventative care. Our attorneys are available to answer any legal question on how to receive the monetary compensation you deserve if your wounds are the result of someone else's negligence. Should you have additional questions, we invite you to contact our office for a free review of your legal rights.
How Bedsores Develop
A pressure wound is a serious medical complication that, with proper care, is completely preventable. Initially, a pressure wound can begin to develop when there is minimal tissue damage just below the upper epidermal skin layers. The areas that are most susceptible to developing a decubitus ulcer include the:
- Lower back
- Shoulder blades
- Sacrum (tailbone)
- Back of the head
Studies show that pressure sores are usually caused by immobility. Elderly nursing home residents, hospital patients, and those who are non-ambulatory tend to be the greatest at risk for developing pressure ulcers. This is because many are inactive when lying or sitting for extended periods.
Prolong sedentary activity where the individual does not shift, reposition or move can irritate body tissue. A bedsore can develop in as little as 90 minutes if blood flow has been restricted to the skin. During its beginning stage, a developing bedsore can completely heal if immediate care is provided. Care includes alleviating pressure to the area and treating the skin if it appears irritated and is warm to the touch. If the medical team or wound nurse fails to treat the area immediately and appropriately, the sore can easily progress to a life-threatening wound. There are for definable stages of a bedsore and one indefinable (unstageable) stage. They include:
- Stage I – During the initial developing stage, the wound has not yet opened at the skin surface but is often painful to the touch without displaying a tear or break. However, the skin will not blanch when touched (the color is not lost when pressed with the finger) but can appear reddened and feel warm. At this early stage, the sore might feel softer or harder compared to the surrounding skin.
- Stage II – If the wound progresses, the sore can begin to break open, wear away and eventually form an opened ulcer that is typically extremely painful and tender to the touch. The wound has now caused damage to the deeper layers of skin and could appear as a blister (with or without clear fluid), abrasion (scrape), or shallow crater. Typically, the damage to the skin is irreversible and beyond repair. In some cases, the progression can lead to necrosis (dead skin tissue) or worse if allowed to progress.
- Stage III – At this stage, the pressure sore has become significantly worse and has caused permanent damage to the tissue beneath the skin. The fat underlying skin tissue may appear in the opened wound just below the skin.
- Stage IV – This life-threatening condition requires immediate medical attention now that the wound has developed into a deep crater. The wound doctor will likely categorize the sore as a stage IV because of the exposed muscles, tendons, ligaments, and bone. In many cases, the patient has developed sepsis (blood infection) or osteomyelitis (bone inflammation due to infection).
- Unstageable – Recently wound doctors have begun to categorize some bedsores as unstageable, where there is substantial damage to the skin and tissue that falls outside the traditional parameter of the four stages of pressure sores. The doctor might suspect that a bedsore has developed but it cannot be confirmed because there is other skin damage or debris in the way or a deep tissue injury (DTI) is present that would not be categorized as a bedsore.
In the later stages of bedsore development, the patient may experience little or no pain because there is severe damage to tissue, muscles, and skin that has killed nerve endings.
When Negligence Is Involved
On average, more than 500,000 nursing home residents and hospital patients acquire bedsores every year. A report released by the CDC (Centers for Disease Control and Prevention) revealed that approximately 10% of all nursing home residents will develop a bedsore while at their residential nursing facility. While this number seems exceedingly high, it has not fluctuated much over the last few decades. Pressure ulcers continue to be a prevalent problem in nursing facilities throughout the United States. Many times, the sores develop because of a lack of attention or the doctors and nursing staff are providing the resident with improper medical care.
The nursing facility must ensure that basic procedures to treat a resident's bedsores are in place. Following proven protocol is especially important to residents who cannot move without assistance and require repositioning by the nursing staff at least every 1.5 hours. If the resident enters the facility with a bedsore or acquires a wound after admittance, the nursing home is responsible for providing appropriate care to ensure the wound does not degrade to an unmanageable condition. Without proper treatment, the wound can progress to a level where it claims the life of the resident.
State and federal nursing home regulations require the staff to perform a comprehensive skin assessment of every resident when admitted, and multiple times throughout the year. If the staff and doctors identify the resident as being highly susceptible to the development of a pressure wound, an effective care plan must be developed, implemented, and enforced to minimize the potential risks of severe skin problems. The care plan should outline specific guidelines on how the nursing staff must provide care to avoid the common causes of pressure wounds that typically include:
- Pressure – The Certified Nursing Aides, Licensed Practical Nurses, and Registered Nurses should ensure every patient at risk of a bedsore is repositioned by the staff at least once every 90 minutes while in a chair, wheelchair, or bed. Repositioning their body will prevent the restriction of blood flow to the skin and underlying tissue.
- Traction – Even minimal sheer force can restrict the flow of blood to the resident's skin. Traction occurring during movement can stretch the resident's skin, causing it to rip or tear. The patients most at risk include those who are propped up in a seated position where the forces of gravity restricts blood flow to muscle, tissue, and skin.
- Friction – Continuous rubbing against clothing, fabric, bedding, or materials may produce repeated friction injuries that can develop a pressure sore or worsen an existing wound. The friction can damage or wear away the top layers of the resident's skin. Because of that, the nursing staff should be careful when repeatedly pulling bed linens under the resident to reposition their body or lifting them out of their chair or wheelchair without using the proper equipment.
- Moisture – Excessive moisture can cause bedsores to even the healthiest residents and cause considerable damage to the outer layers of skin. The nursing staff must ensure that the resident remains dry around-the-clock and replace soiled linens and undergarments soaked in urine.
- Malnutrition – In some nursing homes, the resident is abused and mistreated through less obvious ways including malnutrition and dehydration. An existing pressure ulcer needs proper nutrition and hydration to heal. Malnourished individuals often do not have enough body fat on the bony areas of the body to cushion the underlying muscle and tissue. Doctors should prescribe adequate amounts of protein, vitamin C, and zinc supplements and ensure the resident is receiving a proper nutritious diet.
Insufficient Patient Management
Poorly managed nursing facilities can cause a resident's health to suffer greatly. In some cases, a developing pressure wound is caused by a poorly trained medical team that provides substandard care. To eliminate the potential of developing a bedsore or allow an existing wound to heal the staff should follow proven skin care procedures that include:
- Monitor the resident's skin from head to toe each day. This procedure can detect the early warning signs of a developing pressure wound.
- Reposition the resident's body around-the-clock (one time every 1.5 hours) if they are unable to move without help.
- Keep the resident's clothing and skin as clean and dry as possible to minimize damage to the skin's outer layers.
- Change the resident's bedsheets often to eliminate the spread of infection from one area to the body to another or between residents and staff members.
- Ensure that the resident has and uses the proper pressure-relieving mattress, cushion, and pads.
- Provide immediate medical care given by a highly trained individual specialized in identifying and treating bedsores.
- Perform skin massage on the resident to prevent poor blood flow circulation.
A developing bedsore might indicate that the resident is receiving negligent or abusive care or that the nursing staff failed to report the development of a pressure wound that leaves the resident without necessary wound care treatment.
Holding the Nursing Home Accountable
Federal regulations mandate that every nursing home provide each resident with a level of care necessary to avoid the development of a new bedsore unless it is clinically unavoidable based on a medical condition. In addition, the nursing staff must follow established methods and procedures to prevent the bedsore from becoming infected. However, nursing home abuse, mistreatment, and neglect is still a significant problem in the United States.
Families often take legal action once they become aware that their loved one has developed a serious pressure ulcer while they were a resident at the facility. These families know that every pressure ulcer is preventable and could develop when the resident is being neglected or mistreated and not receiving proper care.
Our law firm is highly successful at litigating nursing home abuse and neglect cases involving inadequate attention and facility-acquired pressure ulcers. Many of our cases are based on the nursing homes with inadequate training, lack of supervision, or not following established protocols as required by the doctors' and nurses' state boards.
When Hiring an Attorney Is Necessary
If you suspect that negligence or abuse caused your loved one to develop a pressure sore, it might be necessary to file a claim for compensation using a competent attorney. The mistreatment could occur if Certified Nursing Aides, licensed practical nurses, registered nurses, or doctors at the facility willfully or neglectfully failed to provide an acceptable standard of care.
Our law firm encourages you to contact Rosenfeld Injury Lawyers LLC at (888) 424-5757 for help. We have successfully obtained millions for our clients to ensure they were adequately compensated to cover their medical expenses, household bills, lost wages, loss of future earnings, pain, suffering, and emotional damage and we can help your family too.
Contact our attorneys today to schedule a free, no-obligation case consultation to discuss the merits of your monetary recovery claim. Our legal team accepts all personal injury case, wrongful death lawsuit and accident injury claims through contingency fee agreements. This arrangement postpones the payment of legal services until after we have successfully completed your case through a jury trial or negotiated out of court settlement.
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