Things that you should know about your future Bed Sore
Is a bed sore in your future? Many people who end up in hospitals or Nursing homes get bed sores. According to the Bureau of Census, the likelihood of ending up in a Nursing home increases as people age. The percentage of people who end up in nurses homes are as high as 5% for people over age 65, 24 % for people over 85 and 50 % for people over age 95.
While age is a more predictable factor for ending up in a Nursing Home, the probability of ending up in a hospital though equally high, is less dependent on age and more on diseases. Some of these diseases are Diabetes, Acute illness, allergic reactions, cancer or heart diseases to name a few. People also get admitted to hospitals due to accidents. According to National reports, in 2010-2012 Diabetes (a high risk factor for bed sores) related conditions alone made up approximately 20% of hospital admissions.
Consequently, unless you have foolproof plan to prevent getting old, or a plan to avoid an illness that requires hospitalization, a bed sore may be in your future.
What is a Bed Sore?
A bed sore or decubiti (pressure ulcer), is an ulceration of the skin that develops on body parts of people who have been confined to an area for extensive periods of time. Bed sores form when there is decreased circulation to a body part from pressure. Decreased circulation to body tissues for extensive periods of time leads to death of the tissue.
Bed sores usually develop in bony areas such as elbows, heels, buttocks, sacral areas and shoulder blades. These are the areas of the body that are most likely to come in contact with firm surface areas for extensive periods of time and may rub occasionally or constantly. Factors such as shearing force (downward and forward pressure on tissues) such as constantly sliding down in a bed and needing to be pulled up, and friction (rubbing or scraping) from bed pads or coarse bed fabrics or plastic liners on beds. They may be caused by repeated exposure to moisture, decreased movement, decreased circulation, decreased sensation, poor nutrition and advanced age. Many people develop bed sores when they are confined to beds, wheel chairs or Geri chairs.
Bed sores are described by their severity. They range from a stage 1 which involves reddening of the skin. Stage 2: The skin is open and there is a visible area of ulceration that may also look like a bruise or a blister. Stage 3: The opening becomes larger and may extend into the tissue. Stage 4: There is a deep wound where bones and tendons may be exposed. Patients who progress to stage 4 usually have more difficulty getting their wounds to heal. They may require aggressive treatment including skin grafts.
People with health conditions such as diabetes, anemia, and dry skin are at risk for bed sores due to the circulation problems caused by these conditions. The aged are also are at risk for bed sores because they have drier thinner skin.
Diabetics and Bed Sores
Patients with diabetes are at increased risk of getting bed sores. Diabetes reduces the circulation in body tissue especially to those areas that are subjected to increased pressure. Reduced circulation results in pooling of blood. The pooling of blood results in tissue break down. Many Diabetics also have neuropathy. Neuropathy is a type of nerve damage. This nerve damage cause Diabetics to have decreased sensation and may not feel the constant pressure in certain areas. As such, they may not feel their heels constantly rubbing against a bed.
People with Diabetes may not feel pressure against their sacral area when seated for long periods in a wheel chair warranting the need to shift position. They may not feel the pressure of a foot such against the foot rest of a wheel chair. When diabetics get pressure ulcers they also have a more difficult time in getting those wounds to heal. Diabetics may have more problems with their immune system. The immune system helps with healing. Many diabetics pressure ulcers may progress to necrosis (death of tissue) causing the loss of an entire toe or foot.
Are Bed Sores Preventable
Bed sores are preventable. Bed sore in health care facilities are often caused by negligence. Many people are aware of the Terri Schaivo story. Terri Schaivo was a young married woman who became the focus of a national right to die debate after she suffered a brain damage. She was bed ridden for 15 years requiring a feeding tube to survive. Her husband defended the care that he provided to her, by declaring that she never developed a bed sore in 15 years. Many people thought that this was amazing.
However, lack of a bed sore on a person that is being given proper skin care should not be seen as amazing. That is the expected standard of care. The skin care that Terry Schaivo received was the care that all patients are entitled to. Terri Schaivo avoided a bed sore because she had family members who were constantly present to ensure proper care. Her family made sure that she was turned and repositioned, and was not forced to lie in her urine and feces on a daily basis.
Turning and Repositioning
Bed sores may occur in Patients who do not get turned or repositioned frequently. Most hospitals have policies in place that require turning and repositioning of patients at 2 hour intervals. Despite these policies, this does not always occur. Hospital staff members in many cases forget to turn patients. Staff may be overwhelmed with other activities or have no help turning a heavy patient at the scheduled time.
Turning and repositioning takes the pressure off bony areas and help to increase circulation in body tissues. Patients who have had had surgeries to their hips, thighs or spinal columns may require period of immobilization. However, these patients can still be repositioned using appropriate techniques.
One patient admitted to a hospital developed a stage 3 pressure ulcer within one week of his admission after a car accident related fracture. His admission assessment revealed that his skin apart from his lower leg fracture, was intact prior to his admission.
A patient with a fractured leg or hip may be repositioned by using a device such as abduction pillow or even a regular pillow. An abduction pillow places a wedge between the hips and keeps the fractured limb in alignment so that it can be moved as a complete unit.
Keeping the Body Free of Moisture
Bed sores often occur when patients are forced to lie in their feces and urine for extensive periods of time. Excess moisture, especially from urine and feces will irritate the skin resulting in bed sores. The bacteria from feces can also cause the wound to become infected making it more difficult to heal. Patients who are incontinent (unable to control their bowel or bladder movements) are more at risk for bed sores.
Finding ways of keeping patients dry will help prevent a bed sore. Some interventions that can be used to keep the skin dry in incontinent patients are; changing a diaper frequently, or establishing a toileting plan whereby the patent is offered a bed pan or urinal and given the opportunity to urinate at regular intervals. In some cases, inserting a Foley Catheter or applying a leg bag may be necessary to keep the skin moisture free.
I have seen bed sores larger than my fists. I have seen bed sores so large that the underlying bones were visible and moving freely. These types of wounds should never occur in a health care setting. Unfortunately, staffing issues and downsizing have led to the occurrences of many preventable conditions such as bed sores in the health care setting.
Tips on how to help prevent bed sores.
- Ensure that relatives who are in wheel chairs change positions, or move around to relieve pressure to buttocks every 15-30 minutes.
- Request that soft cushions be placed in wheel chairs or Geri chairs.
- Assist staff in repositioning or request that your family member be turned and repositioned every two hours while in bed.
- Ensure that your loved one is lifted up in bed by more than one care giver rather than being dragged with a lift sheet.
- Apply lotion to dry body areas to prevent peeling and cracks. Give massages.
- Help to feed relatives and encourage adequate hydration. Bed sores need adequate protein to heal, water to keep the skin supple and adequate vitamins for optimal skin health.
- Prevent your loved ones from lying in urine or feces for extended periods.
- Call Nursing homes and hospital frequently and remind staff to check on your loved ones.
- Visit healthcare facilities as often as possible. Staff usually tries to keep patients clean when visitors are expected.
One Advantage to having a bed sore
There is one advantage to having a bed sore. Your bed sore can be used to deter the occurrence of bed sores in other patients. Medicare has decided that it will not pay for preventable conditions that occur in hospitals. Bed sores are on Medicare’s list of preventable diseases. By making this decision, Medicare has significantly improved the quality of care to many patients.