Comprehensive Care Plans Must Be Instituted to Halt the Incidence of Bed Sores, Pressure Sores and Decubitus Ulcers says Nursing Home Abuse and Neglect Attorney Steven Peck

Written by Adam Peck Category: Nursing Homes January 23rd, 2013 3 min read

Effective prevention and treatment measures depend on a comprehensive care plan that includes scheduled turning and body repositioning in order to stop the incidence of Bed Sores, Pressure Sores and Decubitus Ulcers says Nursing Home Abuse and Neglect Attorney Steven Peck. There is evidence that the frequency and intervals between turnings may be more critical than pressure in the production of pressure ulcers. Tthe practice of turning patients every 2 hours, and this procedure remains the mainstay of prevention strategies. Various other factors clearly contribute to the development of pressure ulcers. However, the best advice still is to establish a regimen in which pressure is completely relieved on all areas of the body at regular intervals.

Providers working with persons at risk need to be able to recognize skin changes that might indicate an impending breakdown. This is particularly true in elderly patients or in patients who are immunocompromised because the signs of impending or fulminating infection are frequently absent in these patients. Systemic signs of infection that mark the need to culture wounds include drainage, leukocytosis, fever, hypotension, increased heart rate, and changes in mental status. Prevention of progression to more serious damage requires immediate, complete elimination of pressure to the involved area.

If the proposition that pressure in excess of normal is the chief cause of pressure ulcers is accepted, then the primary prevention efforts have to be directed toward reducing or eliminating pressure over susceptible areas. The intensity and duration of external pressure and shearing forces necessary for pressure ulcers, bed sores and decubitus ulcers to occur depend on an individual’s susceptibility, which could be summarized as their tissue tolerance. Nursing strategies include prevention of prolonged pressure, elimination of shearing forces and friction, and removal of skin secretions and excretions.

Statistically, 21.2% of patients who underwent surgery for more than 4 hours developed 70 pressure ulcers in the first 2 days following surgery. Twenty-one pressure ulcers, bed sores and decubitus ulcers deteriorated in the days following surgery. More than half (52.9%) of the lesions developed on the heels, and 15.7% developed in the sacral area.

Additional interventions that may be indicated for patients most at risk for pressure ulcers, bed sores and decubitus ulcers include avoiding hot water; using a mild cleansing agent that does not irritate or dry the skin; using moisturizers; using topical agents such as moisture barriers; keeping the sheets dry and wrinkle free; providing adequate intake of protein and calories; and maintaining current levels of activity, mobility, and range of motion. Massaging body prominences should also be avoided since this practice has been associated with increased tissue breakdown and risk for the formation of pressure ulcers.] Positioning devices such as pillows or foam wedges should be used to prevent direct contact between bony prominences (eg, knees, ankles). Donut-type devices should not be used because they are known to cause venous congestion and edema.

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Written by Adam Peck

Expertise: Personal Injury

Adam J. Peck, ESQ is a principal with Peck Law Group, APC. In 2008, Mr. Adam Peck received his Juris Doctorate from Whittier Law School where he graduated Cum Laude. His practice is primarily dedicated to representing Elders, Dependent Adults, along with their loved ones and family members, who have suffered horrific personal injuries.