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January 14, 2023

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Pressure sores are painful wounds caused by prolonged pressure on soft tissue such as skin, muscle, fascia, tendon, ligament, bone, cartilage, or other tissues.

These wounds may occur anywhere on the body where there is constant pressure among people who spend long periods lying down, especially those who are bedridden.

The Braden Scale helps identify patients at risk for developing pressure wounds. Failure to use the scale for predicting pressure-related discomfort could result in preventable skin cracks and open sores.

Did you or a loved one suffer severe skin breakdown and develop preventable decubitus ulcers? Did the nursing home fail to perform a pressure ulcer risk assessment that led to your bedsores?

The personal injury attorneys at Rosenfeld Injury Lawyers, LLC can help hold the nursing home and medical team accountable.

Call our nursing home abuse lawyers at (888) 424-5757 (toll-free phone number) or use the contact form today for immediate legal advice and schedule a free consultation.

All confidential or sensitive information you share with our legal team remains private through an attorney-client relationship.

Pressure Sore Risk Braden Scale

Medical teams use the Braden Scale for predicting pressure sore risk factors.

The scale ranges from 0 to 23 points, where:

  • A number between 0 and 7 indicates no risk of developing a pressure sore
  • An 8 to 14 indicates moderate pressure ulcer risk
  • 15 to 19 indicates high risk
  • 20 or above indicates an extreme risk

Nurses are responsible for screening each patient daily for signs of pressure sores.

They should use the Braden Scale for predicting pressure ulcer contributing factors for at-risk patients requiring additional care.

Body Areas More Prone to Pressure Ulcerations

Pressure sores (decubitus ulcers) can affect any body area, but they most commonly develop around bony prominences such as elbows, knees, hips, shoulders, ankles, wrists, neck, head, and toes.

They can occur anywhere there is constant pressure on tissue weakened due to illness, injury, surgery, or medications. Immobility increases the risk of developing pressure sores.

The American Foundation for Skin Cancer estimates that about 3 million people develop pressure wounds yearly. Of those, approximately 500,000 require hospitalization, and 30,000 die.

Using the Braden Scale for Predicting Pressure Sore Risk

The Braden Scale identifies people who are at high risk for developing a pressure ulcer by assessing their health status using four factors:

  • Patient’s ability to maintain an intact epidermis
  • Presence of edema
  • Patient’s weight
  • Patient’s ability to move freely

Each criterion is scored 0 to 2 points, giving a total score out of 16

Patients are considered low risk if they receive a score of 15 or above. High-risk patients fall into three categories: moderate risk, severe risk, or very severe risk.

Preventing pressure ulcers requires multiple steps to manage each risk factor, including using protective skin barriers and readjusting body position (occasional slight changes in position) every 90 minutes or less.

Other steps involve:

Sensory Perception

A patient at risk for developing a pressure ulcer due to sensory impairment won’t be able to report pain while unconscious or when the patient has limited ability to communicate.


A lack of needed skin moisture is a common concern among immobile people. People often develop problems associated with moisture because they don’t realize how much water they lose each day.

Immobile people usually lose about two quarts of fluid daily, mostly through sweat and urine. Some people lose up to eight quarts of fluid per week.


Pressure wounds are common among the aged and people with multiple sclerosis (MS) and occur when blood flow to skin tissue becomes restricted because of damage to nerves or muscles.

Excessive pressure causes cells to die, leading to open sores, pain, infection, and sometimes even amputation.

According to the National Multiple Sclerosis Society, a person who cannot walk will probably develop a pressure ulcer. People with MS often use wheelchairs or crutches, making standing up and moving around difficult.

In addition, sitting still for long periods increases the risk of developing a pressure ulcer. For example, someone who spends eight hours a day in a wheelchair could develop a pressure ulcer within three days.


Mobility is an important part of healthcare. Patients should be able to move around freely.

There are three levels of movement. Each level of mobility needs a different intervention.

  • A person who makes major changes in their position without assistance is identified as mobile.
  • A person who makes frequent but slight changes in their body or extremity position is ambulant.
  • A person who makes occasional small changes in their extremity position but cannot make frequent or significant changes independently or cannot walk very short distances is called immobile.


Adequate nutrition and fluid intake are essential for healthy skin, hair, and nails. Eating well provides energy and nutrients needed to grow and repair body tissues.

Protein intake is one of the most important macronutrients because it helps build strong muscles, bones, tendons, ligaments, cartilage, blood vessels, nerves, skin, and mucous membranes.


Pressure injuries are among healthcare facilities’ most common types of wounds. They occur when skin is subjected to excessive pressures and frictional forces.

Pressure wounds develop when blood flow is restricted to areas of the skin and underlying tissue, causing damage to the cells. This leads to the breakdown of the tissues and the formation of blisters.

These blisters eventually become open sores called pressure sores.

There are three levels of risk associated with developing a pressure injury. High-risk patients include immobile, elderly, obese, diabetic, incontinent, paraplegic, wheelchair-bound, or confined to a bed or chair for long periods.

The National Pressure Ulcer Advisory Panel (NPUAP) developed a classification system to describe the severity of pressure injuries and provide guidance on prevention and treatment.

  • High Risk – Patients unable to move independently due to illness, disability, or age.
  • Moderate Risk – Patients who can move independently but require assistance.
  • Low Risk – Patients who are ambulatory and do not require assistance while moving about

Acute Care Pathway to Pressure Ulcer Prevention

The Centers for Medicare & Medicaid Services (CMS) recently published a draft guidance document entitled “The Pressure Ulcer Risk Assessment and Prevention Pathways for Acute Care Facilities,” which outlines a process for developing and implementing pressure ulcer prevention pathways for acute care facilities.

These pathways provide a framework for identifying patients with a pressure ulcer risk and providing appropriate interventions to prevent the development of pressure ulcers.

Interventions for pressure-related discomfort will likely involve:

  • Moderate to maximum assistance in the use of protective skin barrier creams
  • Physical therapy to ensure sufficient muscle strength to readjust body position with or without assistance to alleviate pressure points
  • Monitor nutritional intake of a liquid dietary supplement to maximize skin health
  • Timely and accurate reporting to identify any detectable changes that could lead to a developing sore

Comprehensive Skin Assessment Elements to Identify Pressure-Related Discomfort

The Braden Risk assessment is one of the most important steps in providing quality patient care. A thorough examination of the patient’s skin helps identify problems early, allowing for appropriate treatment.

The skin assessment using the Braden scale for predicting pressure wounds involves documenting head-to-toe changes of intact skin to identify every bedsore risk factor.

Staff Roles in Using the Braden Scale

A wound care team includes a variety of professionals who work together to ensure proper healing. These individuals are called “team members,” and each member plays a specific role.

The most important person on the team is the director. They oversee the entire process and communicate with other departments to coordinate quality care.

In addition to being knowledgeable about the hospital policies and procedures, the director must be able to evaluate the patient’s condition and understand the nursing role.

Diagnosing and Treating Specific Ulcer Types

Pressure ulcers occur when soft tissue is compressed against bony areas such as joints, bones, tendons, muscles, cartilage, nerves, blood vessels, and organs. Pressure ulcers develop slowly over weeks or even months.

They usually start as redness, swelling, blisters, and heat.

As the ulcer progresses, it becomes painful and hard to heal. Contact your doctor immediately if you suspect you or someone else has a pressure ulcer.

Stage I pressure ulcers do not require treatment. You can treat stage II pressure ulcers by moving patients into less restrictive positions and providing support surfaces.

Use moist wound care products, dressings, and skin barriers for stage III pressure ulcers. Use compression therapy devices and gait aids. In some cases, surgery may be necessary.

For stage IV pressure ulcers, call 911 immediately. Do not attempt to treat yourself.

Call your physician or emergency medical services.

Diagnostic Tests

The following diagnostic tests are used to evaluate patients with suspected osteomyelitis.

  • Blood cultures – These are obtained by puncturing a vein with a needle and inserting it into a blood culture bottle. This test provides information about the presence of bacteria in the bloodstream.
  • Bone biopsy – A small bone is removed during surgical exploration. The sample is sent to the laboratory and examined under a microscope. If the infection is present, special stains are applied to identify the type of microorganism.
  • Imaging studies – X-rays, CT scans, MRI, ultrasound, etc., are performed to determine evidence of infection.
  • Laboratory testing – Serum levels of inflammatory markers such as CRP and ESR are checked. In addition, white cell counts, differential counts, and microbiological cultures are performed.
  • Treatment – Antibiotics are given based on the findings from the above tests. The nursing staff must make major and frequent changes in position to avoid bedsores, especially when elevated patient-related risk factors are involved.
  • Follow-up – After treatment, follow-up visits occur every two weeks for three months, then monthly for another three months. During each visit, the wound is inspected and recorded.

Hire a Nursing Home Abuse Lawyer to Resolve a Compensation Case

Did you or a loved one suffer preventable bedsores while residing in a nursing facility or other caregiving home? Our personal injury attorneys can provide immediate legal remedies to hold all those responsible financially accountable.

Contact us today at (888) 424-5757, or use the contact form to schedule a free consultation.

We accept all personal injury cases through a contingency fee agreement, meaning you pay no upfront fees until we resolve your case through a negotiated settlement or jury award.


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