The Patient Advocate's Guide to Preventing Bedsores

Whenever a patient is in a nursing home, that patient is at risk of developing a bedsore. Although there are both and federal and state guidelines specifically designed to prevent bed sores, many nursing homes and hospitals have failed to follow these guidelines. As a result, nursing home patients are developing bedsores at an alarming rate. This article is designed to help patients and their families prevent bedsores when in a nursing home.

First, some background. What is a bedsore? A bedsore is skin and tissue that has died because it has not received sufficient oxygen from the body. Since blood carries oxygen to all parts of our body, a bedsore is developed when the blood vessels that feed the skin are compressed or damaged in some manner. The compression or damage prevents the blood from reaching the skin and the skin cells begin to die. If the blood supply continues to be damaged or compromised, more tissue will die. Eventually, the blood supply compromise can infect the underlying tissue, bones and joints. It takes as little as two (2) hours of sustained blood flow compromise to begin this process.

Bedsores are common in the lower back, buttocks and on other boney protrusions that routinely come in contact with a patient’s bed. Although every patient in a nursing home is susceptible to bedsores, the majority of cases are easily preventable. The United States Department of Health and Human Services has published clinical guidelines for bedsore prevention since 1992. These guidelines can be found at www.ncbi.nlm.nih.gov. In addition, all nursing homes are required to enact, publish, and follow similar guidelines to prevent bedsores. Despite longstanding published guidelines, why is it then that nursing home patients continue to develop bedsores resulting in hospitalizations, medical complications and, in some instances, death?

Basically, the failure of healthcare facilities to employ enough qualified staff members is the primary reason for the high incidents of bedsores. Typically, licensed practical nurses that work in a nursing home setting are less experienced and cheaper to employ when compared to registered nurses. Furthermore, the resident to nurse ratio is very high. The nurses are simply unable to spend the necessary amount of time with each patient to ensure that the guidelines are being followed. Sadly, understaffing at nursing homes is a serious problem that leads to patient neglect.

For example, many residents are immobile and unable to regularly reposition themselves while lying in bed. The guidelines require nurses and aides to physically move these patients every few hours to prevent bedsores. Unfortunately, by the time an overwhelmed nurse gets around to checking on the resident, the two-hour time frame in which a bedsore can develop has already expired. Similarly, bedsores are also caused by prolonged exposure of the skin to moisture. It is no wonder then that patients who are left to sit for hours in urine soaked diapers and sheets quickly develop bedsores in places that go unnoticed by the nursing home staff and family members alike. Sadly, the situation spirals out of control and the resident suffers because the staff could not make time to provide them with dry diapers and sheets.

So, what should patients do to prevent these devastating injuries? Fortunately, nursing homes fear the civil tort system where juries can hold them financially accountable for failing to follow the guidelines. Family members should not hesitate to seek legal advice if their loved one develops a bedsore. In addition, family members should go to the web, print up several copies of the guidelines and bring them to the nursing home. Family members should also sit down with the nursing home’s medical director to ensure that the guidelines are being followed with respect to their loved one. They should leave a copy of the guidelines prominently displayed on the resident’s bedside table. Finally, family members should follow-up in writing asking the director of medicine and nursing if the guidelines are being followed on an every other-day basis.

The real key is involvement. Family members cannot sit back and blindly trust that their loved ones are in good hands. Most residents are already in poor health when they enter a nursing home facility. Therefore, any neglect can have serious physical consequences. It is only by being a patient advocate in the manner set forth above that family members can ensure that their loved one is receiving the federally and state mandated required bedsore prevention care. n