Thin-skinned: The problem of pressure sores

We often hear about the prevalence of bedsores in nursing homes. Also known as pressure ulcers or pressure sores, these injuries are a common reason people sue long-term care facilities, and it's easy to find law firms that specialize in this type of litigation.

But pressure sores (medical name: decubitus ulcers) are not unique to nursing homes. About 10% of people being cared for in the home develop pressure sores at some point, according to a report in 2011. So whether you are a caregiver or your loved one is in a long-term care facility, it's important to know the facts about pressure sores and, most importantly, how to prevent them.

People who are confined to a bed or a wheelchair are likely candidates for pressure sores because they don't move around enough to allow blood to flow to the skin. The risks are elevated in older patients, whose skin is thinner to begin with, and diabetics, whose blood circulation may be poor.

Pressure sores range from mild to severe and life-threatening. They typically appear on bony structures such as hips, ankles, heels and the tailbone. Mild symptoms may include pain, burning or itching, and the skin may feel warm or cool to the touch. Severe, or Stage 4, pressure sores can be quite deep and damage tissue, muscles and ligaments. Pressure sores are associated with fatal septic infections and are reported as a cause of thousands of deaths each year in the United States.

And they are completely preventable. The problem I'm seeing is that long-term care facilities have lost so much staff that immobilized patients aren't repositioned often enough. Family members are often the first to notice pressure sores, which are considered a sign of neglect.

Nursing homes are supposed to report the incidence of pressure sores to the Centers for Medicare and Medicaid Services (CMS) as a gauge of quality, but a study last year by the University of Chicago School of Medicine found that self-reported data is highly misleading. The authors of the study caution against using a nursing home's own data when determining where to receive long- or short-term care.

So pressure sores are a huge problem for people who are receiving care - who because of dementia may not even realize they have been injured - and for the people who are caring for them. I'm happy to report, though, there are also many solutions.

Some are low-tech. When considering a long-term care facility, ask if they have practices such as:

• Clock charts at a nursing station that are signed off by the charge nurse

• Music/bells over a loudspeaker to cue every two hours

• Turning and repositioning labels placed on the ends of the patient's bed as a reminder

• Tracking, logging and charting tools that are signed off by a nursing assistant and charge nurse

And there are high-tech solutions available now or in development around the world:

• One of the most common is a mattress with tiny pinholes that allow air to circulate around vulnerable areas. There are also mattresses filled with gel, air, water or foam that redistribute pressure away from vulnerable areas.

• Currently on the market is a device that recognizes and tracks the body position and pressure affecting all 12 bony prominences. It then provides feedback and alerts, along with a generated detailed report.

• There's a wireless sensor system that is placed on the patient's chest and monitors and tracks the patient's activity.

• A Czech company, Good AI, has used image analytics technology in order to predict the likelihood of patients developing pressure ulcers. This allows caregivers to focus on the most vulnerable patients.

• University of South Australia scientists have designed minute optical fiber sensors that can be attached to the upper surface of a mattress to monitor movement and record heart and respiratory rates. Caregivers can be remotely alerted if a patient has not moved within a couple of hours.

• Penn State students built a prototype of a mobile bed frame featuring removable side panels that would allow workers to move patients with the touch of a button.

Technology is great, but it's only as good as the person using it. I once had a bed-bound patient at home on a low-air-loss mattress. The caregiver forgot to turn on the air pump one night, and by morning, the skin on the patient's heels had deteriorated and become necrotic.

Vigilance is the key to preventing pressure sores. And if a pressure sore does develop, don't let it go untreated because it will only get worse.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). Her new book, "How to Be a Healthcare Advocate for Yourself & Your Loved Ones," ► Dec 2022; self publish ◄ is now available on Amazon. She is offering a free phone consultation to Daily Herald readers; call her at (847) 612-6684.