Skin is the single largest organ in the human body, but we tend to take it for granted and do not think of it as alive and having needs like any other organ in our bodies. If blood flow is stopped to an area of skin and muscle, the living tissue dies and the result is a wound or sore. If that wound occurs over a bony prominence (an area where not much tissue separates bone from muscle—the elbows, tailbone, hip bone, shoulder blades) the result is a pressure ulcer.
Pressure ulcers are more commonly called bed sores, because they generally develop in people who are bedridden and cannot shift weight off their bony prominences. They are, literally, sores from being in bed too long.
Pressure ulcers are generally considered to be preventable, as long as appropriate care is given to prevent them from occurring. The necessary care is a simple as turning and repositioning bed bound people every two hours so their skin and muscles receive enough blood flow to keep them healthy. Hospital patients and nursing home residents are at risk for developing pressure ulcers if they are not provided proper care.
Unfortunately, turning and positioning patients requires adequate numbers of nurses and aides to provide the necessary labor. When hospitals and nursing homes cut corners on staffing, turning and positioning is not performed frequently and wounds can quickly develop.
Pressure ulcers can range from relatively minor and superficial wounds (like a rug burn) to a gaping, cavernous wound 10 inches in diameter that goes through the muscle all the way to the spine. Severe pressure ulcers can become so infected that patients die from overwhelming infection. Many people are shocked at how serious pressure ulcers can be, because the term “bed sore” sounds so innocuous.
According to the National Pressure Ulcer Advisory Panel (NPUAP) there are four pressure injury stages:
Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.
Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel. This stage should not be used to describe moisture associated skin damage (MASD) including incontinence associated dermatitis (IAD), intertriginous dermatitis (ITD), medical adhesive related skin injury (MARSI), or traumatic wounds (skin tears, burns, abrasions).
Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.
Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.
As further evidence of the preventability of pressure ulcers when appropriate care is provided, Medicare recently established new rules prohibiting hospitals and nursing homes from receiving reimbursement for medical treatment related to pressure ulcers caused by their poor care. This is a very important enforcement mechanism, because pressure ulcer treatment is expensive and nursing homes and hospitals want to receive Medicare money.
Over the past 15 years, the Orlando pressure ulcer lawyers at Warner & Warner in Casselberry, Florida, have handled hundreds of cases involving severe pressure ulcers, including many wrongful death cases. Our experience in these cases is extensive and our specialized knowledge of the prevention and treatment of pressure ulcers benefits our clients in the successful prosecution of their case against hospitals, assisted living facilities, and nursing homes.
Our Orlando personal injury lawyers have teamed up with some of the most respected experts in the nursing and medical fields to prove negligence cases involving pressure ulcers, including several members of the National Pressure Ulcer Advisory Panel who were instrumental in developing the federal government’s Guidelines for the Prevention and Treatment of Pressure Ulcers.
The Orlando bed sore lawyers at Warner & Warner are passionate about the prevention of pressure ulcers, and we are committed to forcing facilities to provide the basic care necessary to prevent these terrible wounds. If you or a loved one has suffered the pain and indignity of a severe pressure ulcer and live in Maitland, Altamonte Springs, Sanford, Lake Mary, Winter Park, Orlando, Oveido, Apopka, Casselberry or other Central Florida communities, call Warner & Warner. We can help.
