California Elder Law Attorney Blog

Mrs. W is an 80-year-old woman who was recently discharged from the hospital after treatment of a severe infection in her leg that took a very long time to heal. Her hospitalization was also complicated by facility-acquired Clostridium difficile infection. Because she was still frail, Mrs. W stayed with her daughter following discharge. One morning, her daughter found Mrs. W lying on the bathroom floor awake but nonresponsive and unable to move. Paramedics took Mrs. W to the emergency department of the nearest hospital, where it was determined that she had had a stroke. Mrs. W was admitted to the intensive care unit. On admission, nurses documented a bruise on her right trochanter that was assumed to have been caused by the fall . Eventually this bruise opened up into a full-thickness pressure ulcer.

Noting that Mrs. W was at high risk for a pressure ulcer, bed sores, and decubitus ulcers prevention interventions and skin protection were instituted immediately. Mrs. W was moderately obese and had diabetes, hypertension, and hypothyroidism. She also had evidence of poor peripheral perfusion, and her "tissue tolerance" was judged to be unusually low. These factors probably played a role in the rapid deterioration of Mrs. W's bed sore, pressure sore and skin ulcer and the inability of the nursing staff to halt the progression of the injury despite prompt and diligent nursing care. However, Mrs. W's family was angry about the pressure ulcer, blamed the nursing staff, and initiated a lawsuit against the nurses and the hospital.

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Many factors contribute to the development of Pressure sores also known as Bed Sores and Decubitus Ulcers. Pressure leading to ischemia is the final common pathway. Tissues are capable of withstanding enormous pressures when brief in duration, but prolonged exposure to pressures initiates a downward spiral towards ulceration.

Impaired mobility is an important contributing factor. Patients who are neurologically impaired, heavily sedated, restrained, or demented are incapable of assuming the responsibility of altering their position to relieve pressure. Moreover, this paralysis leads to muscle and soft-tissue atrophy, decreasing the bulk over which these bony prominences are supported.

Contractures and spasticity often contribute by repeatedly exposing tissues to pressure through flexion of a joint. Contractures rigidly hold a joint in flexion, while spasticity subjects tissues to considerable repeated friction and shear forces.

Sensory loss also contributes to ulceration, by removing one of the most important warning signals, pain.

Paralysis and insensibility also lead to atrophy of the skin with thinning of this protective barrier. The skin becomes more susceptible to minor traumatic forces, such as friction and shear forces, exerted during the moving of a patient. Trauma causing deepithelialization leads to transdermal water loss, creating maceration and adherence of the skin to clothing and bedding, which raises the coefficient of friction for further insult.

Malnutrition, hypoproteinemia, and anemia reflect the overall status of the patient and can contribute to vulnerability of tissue and delays in wound healing. Poor nutritional status certainly contributes to the chronicity often observed with these lesions. Anemia indicates poor oxygen-carrying capacity of the blood. Vascular disease also may impair blood flow to the region of ulceration.

Bacterial contamination from improper skin care or urinary or fecal incontinence, while not truly an etiological factor, is an important factor to consider in the treatment of pressure sores and can delay wound healing

Continue reading "There Are Many Distinct Factors Which Contribute to The Development of Pressure Sores, Bed Sores and Decubitus Ulcers says Elder Abuse Attorney Steven Peck" »

The best preventative measures for bed sores are to use positioning techniques, clean linens, and repositioning. Positioning techniques include using pillows or rolled towels under the bony prominences for cushioning. Clean linens will prevent traction sores as well as prevent moisture that can compromise their skin integrity. Lastly, bed-bound or wheelchair- bound patients should be repositioned at least every 2 hours. Repositioning a patient allows blood flow to return to areas that may have been previously cut off. Air mattresses, especially those which automatically partially inflate and deflate on a timer, can keep patients who are unable to move from developing pressure sores.

Prevention is the key for bed sores, but if one does develop, there are a few ways to help the patient heal their wound. A well-balanced diet helps heal existing wounds and prevent new ones. A diet high in protein will benefit those at risk for decubitus ulcers. Also, Vitamin C and Zinc also aid the body in repairing damaged skin cells. Other vitamins that aid in skin renewal are Vitamin A and B-Complexes, as well as Vitamin E. If incorporating these into the diet of the individual is hard or impossible, supplements may be used.

Continue reading "Prevention Is the Key To Halt the Development of Bed Sores, Pressure Sores also known as Decubitus Ulcers" »

About 11,000 people suffer spinal cord injuries every year in the USA, and more than 250,000 people are living with this type of injury.

More than one-third of people with spinal cord injuries develop bed sores, also known as pressure sores, pressure ulcers or decubitus ulcers. Complications from such bed sores kill 60,000 Americans a year. That's twice the number who die from prostate cancer. About 8% of those with spinal cord injuries die from bed sores and pressure sores.

They can be caused by friction, when a paralyzed person slides down in bed, or when the body presses on a vulnerable area and cuts off the blood supply. Tissue can die within hours. If bacteria from infected bed sores spread to the blood, patients can develop an infection called sepsis, which can be fatal says California Nursing Home Abuse and Neglect Lawyer Steven Peck.

Continue reading "People With Spinal Cord Personal Injury Can Easily Develop and Die From Infected Bed Sores, Pressure Ulcers also known as Decubitus Ulcers" »

Pressure ulcers -- better known as bedsores and decubitus ulcers -- are lesions on the skin that are caused by unrelieved pressure resulting in tissue damage. They usually develop over bony areas of the body, often in the lower limbs (ankles and hips are common), but they can occur almost anywhere (for example, in the nostrils of patients with feeding tubes, in the corners of the mouth in patients with endotracheal tubes, and between fingers in patients with rheumatoid arthritis).

Pressure ulcers are quite common in hospitals and other institutional settings. In acute care hospitals they occur in about 3-15 percent of patients; they occur in about a third of elderly patients who have had hip fractures; and the number rises to as much as 50 percent in critical care patients. Ten to 35 percent of patients admitted to nursing homes have pressure ulcers, though this rate decreases somewhat for patients who have been there longer. Because there are other reasons for skin breakdown, it is important to be examined and diagnosed by a doctor so that the appropriate treatment can be determined.

Continue reading "Pressure Ulcers, Bed Sores also known as Decubitus Ulcers Are Caused By Unrelieved Pressure" »

Litigation adds to the burden of health care costs. This is especially true in long-term care, where nearly 87% of verdicts and out of court settlements against facilities are awarded to the plaintiffs. One report reviewed 54 nursing home law suit cases from September 1999 to April 2002 involving pressure ulcers.

The average monetary recovery was more than $13.5 million and included awards of up to $312 million in one case, when determined by a verdict or settlement. In litigation cases related to pressure ulcers, jury awards are highest for multiple causation factors. When awards were related to single causes, the highest awards were for those where inadequate nutrition was alleged to be the cause of pressure ulcers .

However, it is important to note that in the past few years a few states have passed legislation limiting malpractice awards which may help to control these cost burdens in the future.

Continue reading "Litigation Costs Are Very High In Cases Involving Bed Sores, Pressure Sores and Decubitus Ulcers" »

The Braden Scale is an excellent nursing assessment tool for evaluating a patient's general condition. It should alert us that a patient requires our utmost vigilance. However, implementing preventive measures should be similar to implementing universal precautions - every at-risk patient, no matter what the Braden Scale score, should be afforded the best preventive care possible. There should be zero expectation that any patient will develop a pressure ulcer. The Braden Scale has no predictive validity unless the assumption is that the care is going to be inadequate.

Pressure ulcer and Bed Sore prevention, to use the old cliche, is a 24-hour-a-day job. On a daily basis, we are entrusted with the care of thousands of at-risk patients. Are we honestly up to the challenge?

Continue reading "Every At Risk Patient for Bed Sores, Pressure Sores and Decubitus Ulcers Must Be Afforded The Best Preventive Care Possible" »

Pressure Ulcer Definition

A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.

Pressure Ulcer Stages

Suspected Deep Tissue Injury:

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Further description:

Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

Stage I:

Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Further description:

The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate "at risk" persons (a heralding sign of risk)

Stage II:

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

Further description:

Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
*Bruising indicates suspected deep tissue injury

Stage III:

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

Further description:

The depth of a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible or directly palpable.

Stage IV:

Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Further description:

The depth of a stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable.

Unstageable:

Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Further description:

Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as "the body's natural (biological) cover" and should not be removed.

Continue reading "How Are Bed Sores, Pressure Sores and Decubitus Ulcers Staged says California Nursing Home Abuse and Neglect lawyer Steven Peck" »

Mobility and activity limitations are strong independent predictors of pressure ulcers. The recent NPUAP-EPUAP guideline states that if the individual is bedfast or chairfast and immobile, he/she is considered to be risk for pressure ulcers. Other factors (eg, nutrition, moisture) mayhave an impact on risk status, but activity and mobility limitations are the primary considerations.

Turning or repositioning the immobile individual helps reperfuse ischemic skin, temporarily removing pressure from vulnerable tissues. Repositioning may include partial turns or small body movements that do not always remove pressure from the sacrum or heels rather than full turns of 30° or more that lift the sacrum from the bed. .

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If you have ever been confined to bed for any length of time, you probably understand how bedridden people can develop pressure ulcers, also known as bedsores. Lack of movement greatly reduces circulation in the body, and pressure against the skin reduces blood supply to that area and the affected tissue dies. Pressure ulcers start as a red area of the skin that does not turn white when pressed. This develops into a blister or open sore and then forms a crater. Pressure ulcers are very painful and tend to develop more on areas where the bones are close to the skin, such as elbows, heels, hips, ankles, shoulders, back and the back of the head, although they can certainly form anywhere on the body.

While there are many different therapies for preventing and treating pressure ulcers such as using sheepskin and powders sprinkled on bedding to reduce friction, one of the best and most proven therapies is to use a Low Air Loss and Alternating Pressure mattress.

The longer it takes for any wound to heal, the greater the risk of infection, re-hospitalization or surgery. Anyone with circulatory issues such as those with diabetes, severe burns or obesity, or individuals who are unable to move due to brain injuries or disabilities can certainly benefit from an overlay air mattress that not only provides effective pressure redistribution, but by combining the overlay with the microprocessor-controlled pump, it provides direct low air loss at the interface of the patient and the support surface to assist in managing the microclimate to help prevent skin maceration.

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Maintaining or improving the ability to move around is one of the most effective ways to minimize the risk of developing bed sores, pressure ulcers also known as decubitus ulcers. People who are not confined to bed should be encouraged to move from bed to chair and to stand and walk. Attention to posture, balance, and weight distribution (eg, shifting weight every 15 minutes) can help people when sitting. People who are bedbound can still benefit from various exercises that put their joints through a range of motion.

Bedbound people should be repositioned frequently to relieve pressure over bony areas. How often someone should be repositioned depends on the person's health and the quality of the supporting surface (eg, some beds are designed to decrease the pressure on bony areas of the body). Older adults at risk of developing pressure ulcers should be repositioned at least every 2 hours.

People who are likely to develop pressure ulcers should be repositioned often, changing from the back to their right side and then to their left side, keeping the back at a 30° angle to the bed surface. This avoids direct pressure on the bony areas of the lower back, hips, heels, and ankles-the sites where 80% of all pressure ulcers develop.

Continue reading "The Best Way to Deal With Pressure Ulcers is to Prevent Them Before They Start" »

Pressure sores, Bed Sores also known as Decubitus Ulcers can be treated, and often cured, by adjusting the patient's position regularly. They are most often caused by sitting in the same position for extended periods of time, which ultimately impedes blood flow to the affected areas. Once the patient has been repositioned, the wound must be cleaned and properly dressed to prevent further infection. It's a fairly straightforward system of care, but if left untreated, pressure sores can extend deep into the tissue, leaving an open wound. In severe cases, the wound will extend to the muscle, tendon, or bone.

Unfortunately, though the steps of treatment are uncomplicated, negligent nursing homes fail to provide this care to residents, which ultimately results in the patient's death. If you or a loved one is in a situation involving nursing home negligence, you may feel that help is beyond reach. Our Peck Law Group nursing home abuse and neglect attorneys have handled hundreds of cases and have fought relentlessly on behalf of mistreated patients, and we will help you!!!

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Serious personal injury cases routinely occur in Nursing Homes causing wrongful death says Peck Law Group Accident and Injury Lawyer Steven Peck.

Take the example of a recent case that involved a horrific infected bed sore also known as a pressure ulcer and decubitus ulcer, which as a result of the infection caused the elder individual to become septic. A terrible way to die!!

Negligence is a required component of a wrongful death action and a personal injury accident. The outcome of the investigation into this accident will be of great interest to those families who have sustained the loss of a loved one and to those who have been critically injured as a result of the neglect of the skilled nursing facility.

Medicare patients at St. Joseph's Medical Center in Yonkers, N.Y., had the second-highest rate of severe bed sores in the country, according to an analysis of Medicare data between Oct. 1, 2008, and June 30, 2010, by the Sunlight Foundation Reporting Group on medical errors.

Medicare patients at St. Joseph's suffered 13 instances of severe bed sores during their stay requiring additional treatment, a rate of nearly 2.9 per 1,000 treated, according to the report. At nearby St. John's Riverside Hospital, the rate was 20 times lower: Only one severe bed sore was reported, even though the larger St. John's discharged 8,270 Medicare patients during the period, compared with St. Joseph's 4,541.

Bed sores--pressure ulcers--are one of the conditions that the federal government is increasingly unwilling to pay for. Earlier this month, Health and Human Services Secretary Kathleen Sebelius announced the Partnership for Patients, a new national effort that is meant to stop millions of preventable injuries and complications in patient care over the next three years. The federal agency said the initiative has the potential to save up to $35 billion in health care costs nationally, including up to $10 billion for Medicare.

The federal government is asking hospitals to focus on nine types of medical errors and complications where the potential for dramatic reductions in harm rates has already been documented. They include pressure ulcers, as well as preventing adverse drug reactions, childbirth complications and surgical site infections.

Continue reading "Elderly Patients At Long Term Care Facility Have An Extremely High Rate of Pressure Sores and Bed Sores says Los Angeles Nursing Home Abuse and Neglect Attorney Steven Peck" »

Bed sores can happen to anyone with limited mobility, but those with diabetes are especially at risk for developing these pressure sores. Bed sores are caused by lying or sitting in one position, trapping skin and tissue between the bones and the bed or wheelchair. The blood pools in one spot and cannot flow properly, causing damage to the tissue. Diabetics are not only more prone to bed sores, they also have a more difficult time recovering from pressure sores.

Poor Circulation

Diabetes causes poor circulation, which prevents the blood from doing its job of delivering fresh oxygen to a wound and carrying away toxins. This poor circulation can make diabetics more prone to developing bed sores because pressure sores are caused by the pooling of blood.

Increased Infection Rate

The open wounds associated with bed sores are a breeding ground for bacteria. People with diabetes get more infections, according to elder abuse lawyer Steven Peck. The National Diabetes Information Clearing House website goes a little further, saying high blood sugar feeds germs and makes the infection worse.

Obesity and Lack of Mobility

Diabetes is linked to obesity and lack of physical movement, according to The Obesity Society. Obesity and this lack of mobility can increase the chance of developing pressure sores. Bed sores are caused by weight pressing on small areas of the back and buttocks for long periods. If the person is very heavy and does not move frequently, he is more prone to pressure sores.

Continue reading "Individuals with Diabetes Are At a Greater Risk For Bed Sores Indicates San Diego Nursing Home Abuse and Neglect Lawyer Steven Peck" »