A bed sore, also known as a decubitus ulcer, pressure ulcer, or pressure sore, is a wound that is caused by pressure on a bony part of the body. Historically, medical experts thought that all pressure ulcers were preventable. Now, medical experts tend to agree that almost all pressure ulcers are preventable with appropriate turning, repositioning, food and protein intake, and liquid intake. To understand bed sores, it is important to remember that the skin is the body’s largest organ. The skin needs blood and oxygen to survive. When a person lays or sits down without moving, the areas where bone pushes against the skin can decrease circulation. If that occurs for too long, the skin can break down and a pressure ulcer can form. This happens faster in the elderly, particularly if that person is malnourished or dehydrated.
Bed sores are staged from Stage I up to Stage IV. Stage I is simply a red mark on the body which does not have capillary refill (labled as non-blanchable erythema). If the red mark is pushed in, it should turn white then back to pink or red. If a Stage I pressure ulcer is pushed in with a finger, it will turn white and stay white for a while because the blood does not return to the skin as it should. A Stage I bed sore only affects the outer layer of the skin. If it is left untreated, it may progress to Stage II, where the skin opens up (partial thickness skin injury). This is a shallow open ulcer. If the wound continues to progress, it can become a Stage III bed sore (full thickness skin loss). The skin opens up so that subcutaneous fat may be visible. However, the bone, tendon and muscle are not exposed. Finally, if the wound progresses further, a Stage IV decubitus ulcer can develop (full thickness tissue loss). Stage IV bed sores expose the bone, tendon or muscle.
While bed sores are not ALL preventable, the vast majority are. Experts agree that to prove that a pressure ulcer was not preventable, the burden is on the hospital or nursing home to show that it did everything in its power to prevent the development of the pressure ulcer but nevertheless failed to do so. That burden is not easily met, especially since many medical records are contradictory and can be refuted with actual testimony of the patient, family and friends, and even nursing staff.
Pressure ulcers cause other problems too. For instance, if the bed sore develops on the sacrum or the coccyx (or anywhere else around the groin region), and it progresses to Stage III, then a Foley catheter is usually indicated to prevent infection. Of course, that only increases the chances of developing a urinary tract infection.
Pressure ulcers are also very painful. The pain requires strong medication which can affect your loved one’s overall affect, demeanor and quality of life.
For additional information on pressure ulcer development, look at the information provided by the National Pressure Ulcer Advisory Panel on the internet. You can also call Dave Goddard or Eddie Wagoner of Goddard & Wagoner PLLC, a West Virginia law firm handling cases in West Virginia, Ohio, Pennsylvania and surrounding states. See www.GoddardLawWV.com or call (304) 933-1411.
