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Bed sores which are also known as pressure ulcers or pressure sores may be caused or worsened as a result of neglect by nursing staff involved in the care of the elderly especially in residential care homes. Bedsores that are detected at an early stage in their formation can be treated and completely healed however failure to deal properly with bed sores may cause life threatening complications. A failure to properly deal with bed sores may result in medical negligence solicitors taking legal action in a court of law claiming damages for personal injury.

Diagnostic Tools

Healthcare professionals including nurses in residential care homes may use diagnostic tools which categorise bed sores, pressure ulcers and pressure sores using different factors in order to predict risk and determine their outcome thereby dictating the relevant treatment. Whilst it may be difficult to suppress the initial incidence of a bedsore, once established there should be adequate treatment failing which there is likely to be a finding of medical negligence on the part of healthcare staff which may result in medical negligence solicitors taking legal action in a court of law claiming damages for personal injury.

Pressure Ulcer Causes

Bed sores, pressure ulcers and pressure sores are localised areas of damaged tissue caused by compression usually between a bony prominence and an external surface which may include a bed, a wheelchair and in some instances another part of the body. A bedsore can result from just one prolonged incidence of pressure however most bed sores are the result of repeated incidents whereby blood flow has been interrupted to a particular area of the body on numerous occasions. In addition incontinence often plays a part due to irritation as a result of skin being constantly wet.

Documentation of Bed Sores

Whenever a resident of a care home develops a bed sore, a pressure ulcer or a pressure sore there should be full documentation available, including notifications of any wounds with descriptions of size, odour, drainage, presence of necrosis etc. In order to determine the issue of neglect a medical negligence solicitor will investigate whether the resident's pressure sore is consistent with the documented information which should include a position record indicating the amount of time the patient spent in each position.

Bedsores - Medical Negligence Solicitors

In the event of inadequate care which is often documented in the patient records a medical negligence solicitor may take legal action to claim financial compensation. Means tested legal aid may available to the elderly in order to pursue a medical negligence claim and in most other cases we are able to offer a no win no fee* scheme. To speak to a solicitor today for fee legal advice with no further obligation just call the helpline.

Bed Sores - Facts

Bed sores are also known as pressure ulcers or pressure sores and include injuries to the skin from long lasting pressure on the skin. They are, for the most part, completely preventable and usually show up on the bony points of the body, including the ankles, heel, hips or buttocks. Rarely do they show up on the upper back or upper extremities. Those that develop bedsores are those who have a medical or physical condition such that they cannot move around and are confined to a bed or wheelchair much of the time.

Bedsores are easier to prevent than they are to treat. This is why it is incumbent upon healthcare professionals and healthcare facilities to do what they can to prevent bedsores from happening. There are several techniques that can be employed that keep bedsores at bay and promote bedsore healing if they occur.

There are several stages of bedsores. They include stage I bedsores, in which the skin is redder than surrounding tissue but the skin has remained intact. The skin doesn't blanch when touched and the location of the stage I bedsore may be sore and warm or cool to the touch when compared to nearby skin.

Stage II bedsores represent an open wound with the epidermis layer missing and part of the dermis is gone or damaged. It looks like a shallow ulcer or perhaps a bulging, fluid filled blister. Stage III disease represents a deeper ulcer that exposes a bit of fat. The epidermis and dermis are lost and the ulcer appears like a crater. There is dead tissue within the wound and damage may extend into the fatty or deeper layers of tissue. In stage IV bedsores, the wound can expose bone, muscles or tendons. There is a black eschar of dark and crusty dead tissue at the base of the wound and damage extends beyond the border of the original wound.

Wheelchair-bound people tend to get pressure sores on their buttocks or tail-bone and some get sores on their spine or shoulder blades. The parts of the arms or legs that rest on the chair can get bedsores as well. Bed-bound individuals tend to get sores on the back of the head, around their ears, on their shoulder blades, on their hip, tail-bone or lower back or on their heel or ankles. The skin behind the knees can even be affected.

Nurses, doctors, nursing aides and other caregivers need to inspect the skin carefully on a regular basis and do what it takes to prevent sores from getting past stage I. Frequent moving around in the bed or wheelchair with position changes is necessary to prevent disease from occurring in the first place. Care should be taken whenever a person with a bedsore gets a fever or shows purulent drainage from a sore or develops increased heat and redness surrounding a bedsore.

The cause of a bedsore is pressure against the skin such that there is inadequate blood supply to the skin and underlying tissue. The three main contributing factors to bedsores include sustained pressure to a certain area of the skin, especially those overlying bony prominences. Friction around these areas makes the chance of bed sores worse. Friction gets worse when the bedding or the skin is moist or wet. Shear forces make bedsores more likely. They occur when a person slides down in a bed, moving the bone down on the bed but keeping the skin in place where it was. This shears off the skin from the underlying bone and makes the bedsore more likely to happen.

Risk factors for getting bed sores include being of an older age, which makes the skin more fragile, poor health, which impairs healing of tissue, weakness, which limits mobility, paralysis, long term bed or wheelchair use, sedation or loss of consciousness for long periods of time, postoperative recovery, lack of perception of sensation such as in spinal cord injuries, diabetic neuropathy or other causes of neuropathy, and poor nutrition and poor hydration.

Patients who have urinary and faecal incontinence are at a greater risk of getting bed sores. Fecal matter can increase the risk of infection in bedsores. Sweating excessively or being too dry in the skin can make the skin more likely to be injured. Diabetes and peripheral vascular disease can make one at increased risk of bedsores. Smokers get bedsores more likely to get bedsores and those who have decreased mental awareness have a greater risk of damage to the skin. People with muscles spasms or abnormal movements that they cannot control can get bed sores at a greater rate.

Bedsores have complications that extend beyond a simple bedsore. The individual can develop sepsis of the bloodstream from bacteria that enter the system through the sore. They can develop cellulitis for the same reason and infections can spread to the joints or bones underlying the bed sore. Chronic wounds can actually lead to cancer of the tissue that requires surgical treatment to treat.

Fortunately, the treatment of stage I and stage II ulcers is relatively easy. Caregivers need to cushion the wound at all times and provide cleansing to the wound so it doesn't get infected. There are special heal covers and other devices that take the pressure off the wound. Bony surfaces especially need to be protected from further damage. Stage III and IV ulcers are prone to infection and are more difficult to treat, especially if the person has a chronic illness or cancerous disease. Terminally ill people are more prone to getting bedsores and these are extremely difficult to treat.

Repositioning the person with bedsores is extremely important. It must be done regularly and it should be done in such a way that the pressure is off the sores. Lifting devices can be used to regularly reposition a bedridden person. Staff can use special pads, mattresses or cushions to keep pressure off the bedsore and to keep a person in a particular position so they have pressure off the wound. Foam devices and water-filled devices can be used to prevent pressure on the buttocks and behind the legs and back when a person is sitting on a wheelchair.

A surgeon must be available to remove dead tissue from the wound in order to start the healing process. The body can also remove dead tissue on its own but this sort of thing needs to be watched very carefully. This is called autolytic debridement. Pressurized irrigation can remove dead tissue such as in a whirlpool bath or through the use of specialized dressings. Certain enzymes can be used to break down damaged tissue and can be used within the wound as part of the dressing.

The wound must be clean at all times and dressed if greater than a stage I bedsore. Saline is used to clean the wound before adding a dressing. The wound must be kept moist to promote healing and must have some kind of barrier to prevent infection from occurring. It is the role of the doctor to select the proper dressing.

Bedsores are completely preventable and the development of a bedsore may represent negligence on the part of the doctor or nursing staff taking care of the patient. All patients with mobility problems need to have regular repositioning and aggressive care of stage I and stage II ulcers so they don't worsen. This means they need to have their skin looked at daily and changes made according to the examination of their skin.



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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here