In both acute and long-term care facilities, lawsuits for pressure wounds or “bed sores” have become common. Many practitioners argue that in some clinical cases, the instances of pressure wounds cannot be avoided, however best practice for all sedentary patients requires a treatment plan to prevent and to address the issue as an important health risk. Beyond pain and discomfort, in a medical environment, open wounds present a secondary risk of contracting bacterial and viral infections that can be life threatening.
Family members and guardians should be educated on the prevalence and causes of bed sores, and be prepared to advocate for the patient for treatment. If the patient appears to be suffering repeated or severe instances of pressure wounds, negligence and neglect can be investigated legally, and medical care facilities can be found guilty of malpractice if appropriate modalities of care have not been followed.
Individuals in hospice, home health or acute and long-term care facilities represent some of the most vulnerable patients in the health care system; their well-being is entirely contingent on the professional medical support they receive. However increasing demands on medical care teams coupled with budgetary cuts and fewer nurse aides present a higher risk for bed sores to go undetected. We’ll explain what your family needs to know to help protect a loved one, and take legal action, if required.
Medical Teams Are Required to Chart and Document Pressure Wounds
Bed sores for at-risk patients can escalate into lesions on multiple locations of the body, and are prone to bacterial infection and Sepsis. Where a patient has experienced many lesions or severe bed sores, the human body has a defensive mechanism (Sepsis) which attempts to fight against systemic infection. It does so by killing tissue (skin and muscle) around the area of infection.
When a patient has become Septic, chemicals are released into the bloodstream that target the bacterial infection, by placing the body in an inflammatory state. This inflammation can impact not only the immune system, but also create strain on vital organs, causing organ failure. Septic shock is a progression of the inflammatory response, and it causes blood pressure to rapidly drop, leading to an increased risk of fatality.
Charting the development of pressure wounds is imperative for health care providers, because documentation allows the health care team to watch for progression. In bed sores, there are four stages of escalation for the condition, that families and patient guardians should be aware of:
In the first stage of development, bed sores are not open wounds. They may resemble “hot spots” where the skin appears warm to the touch, or red (in fair skinned patients). To the touch, the area that is developing a pressure wound may feel softer than the tissue surrounding the area, or harder and more calloused, depending on the type of skin and location of the pressure point.
At the second stage of pressure wound development, the skin separates, breaks open or forms what appears to be a ‘hole’ in the skin that has a hollow area below the dermis (ulcer or blister). By the time an ulcer has developed, the skin has been extensively damaged and the area may not heal itself, even with medical attention. In those cases, physicians will remove the damaged skin to prevent further infection, a surgical procedure to remove necrotic tissues, called debridement.
In this stage, the pressure wound extends deeper below the dermis, and forms a hollow hole, that may reveal fat cells. Stage three pressure wounds are excruciating and sealing the wound with reconstructive surgery is not an option, until the bacterial load has been resolved. For hospice patients or those with a terminal illness, care focuses more on making the patient comfortable and pain free, rather than subjecting the patient to riskier evasive surgical procedures.
The most serious stage of bed sore development involves a wound that goes so deep, that muscle and bone can be seen through the wound. The patient may develop Sepsis, and depending on the level that his or her immune system has been compromised, hyperbaric oxygen therapy or negative pressure wound therapy (NPWT) may be used. As severe bed sores tend to develop on the back, shoulders and buttocks for sedentary or immobilized patients, cross infection from feces may require a colostomy to divert waste away from open wounds.
One of the greatest challenges in stage 4 bed sore treatment, is encouraging the body to heal the wound area. While surgery can help close the wound, if the skin around the blister or crater is too damaged, it will not close. Discomfort and movement to prevent new bed sores from occurring, can also tear existing wounds and make them larger for the patient.
Intervention for Patients
Patients that develop bed sores are immune-compromised and may be prone to contracting pneumonia and other upper respiratory diseases, influenza, norovirus, tuberculosis and other life threatening infections common to hospital or long-term care environments. In some patient cases, prolonged and unresolved bed sores may contribute to preventable patient morbidity and wrongful death.
It is important for family members to intervene if they feel that inadequate care has contributing to a problem with pressure sores. Patients must be kept dry, and cleaned regularly to reduce their risk of contracting bed sores; unfortunately, it is not uncommon for the elderly or chronically ill to receive less attention and physical activation, than other patients who can speak and advocate for their own care.
Damages in pressure sore litigation cases vary, depending on the case and the level of negligence exhibited by the primary care team. In cases of gross morbid obesity, where the patient required machine support to lift and turn, or where mental health needs required restraint and limitations to movement for patient safety, it may not be possible to pursue malpractice. However, in other cases, where wound care protocols were not followed by the primary patient care team, and the infection contributed to organ failure or wrongful death due to negligence, families may be able to pursue legal action successfully.