How to Prevent Abuse and Neglect in Nursing Homes: Prevention of Pressure Sores
By Ted Sherwood
If your loved one is frequently bed or chairfast, this can present special challenges to prevent him or her from developing pressure sores. Prevention is extremely important, because once a person’s skin begins to breakdown they are at significant risk for development of infection. We have seen a number of nursing home residents require extensive surgery, prolonged hospitalizations, amputation and even death, due to the failure of the nursing staff to prevent skin breakdown.
A pressure sore is an area on the body that has suffered a compromise of circulation for a sufficient length of time to cause the tissue to die. Pressure sores typically develop over bony prominences such as the tailbone, hips, knees, elbows and heels. If an opening in the skin develops, the wound is very susceptible to infection because people who are bed or chairfast are also frequently incontinent of bowel and bladder and suffer from frequent urinary tract infections. A pressure sore which becomes infected is literally a matter of life and death. These are our suggestions as to what you can do to monitor the nursing staff’s effort to prevent or treat pressure sores:
- Make sure that your loved one is properly assessed for prevention of skin breakdown. Ask the nursing staff what steps they intend to take to prevent skin breakdown. This will usually include repositioning the resident every two hours, or more; keeping the resident clean and dry; and maintaining proper nutrition and hydration.
- Talk with the doctor about his thoughts on how to prevent skin breakdown.
- Make sure that the nursing staff takes the steps indicated by its assessment. In other words, you must check and make sure that your loved one is being repositioned frequently.
- If you find the resident wet or soiled on a frequent basis, you must take action. If you find the resident continues to lose weight you must take action.
- If skin breakdown occurs, it is imperative that you double and redouble your vigilance. Most people can heal a Stage I pressure sore (redness) or even a State II (opening in the skin) if, and only if, the nursing staff continues to keep pressure off the area of skin breakdown; keeps the area clean and free of contamination of urine or feces; and the resident maintains good nutrition. However, the mere fact of skin breakdown is often an indication that the resident is being neglected.
- You must ensure that the nursing staff is, in fact, repositioning the resident every two hours, or more frequently if that is not sufficient. The nursing staff may have to use pressure relieving devices such as padded boots or special mattresses.
- You must ensure that the nursing staff has notified the doctor of the skin breakdown and is following his orders of treatment.
- You should inspect the pressure sore on a regular basis and, if the wound is not getting better, or is getting worse, you should insist that the doctor come and examine the wound personally. That is because it is not unusual that the resident’s doctor will see the resident every sixty (60) days unless there is an emergency. If the nursing staff has not correctly assessed the pressure sore, which frequently happens, or has not notified the doctor that the sore has worsened, the pressure sore can get out of control.
- If the wound smells bad, it is time to go to the emergency room.
