Pressure ulcers are debilitating chronic wounds that cause torture and suffering to those inflicted, and in severe cases carry the substantial probability of death. Elderly residents of Alameda County and Bay Area nursing homes with physical and or cognitive impairments- especially those with a higher number of medical problems- face the greatest risk of development of pressure sores if they are denied the necessary and appropriate preventative measures. But regardless of any co-morbidities or underlying medical problems, pressure ulcers are by and large preventable.
Because pressure ulcers are preventable, their development is used as a quality indicator for long-term care facilities (nursing homes or “Skilled Nursing Facilities”), hospitals, and effectiveness of physician care. A recent study published in the May 2011 issue of the Clinics in Geriatric Medicine suggests that to effectively prevent pressure ulcers, nursing homes must frequently assess the health condition of a patient. This includes nutrition, mobility, risk for friction and shear, activity level, incontinence, and skin condition. After assessing each patient, an individualized care plan should be developed and implemented for each and every patient in order to effectively prevent pressure ulcers.
The article, titled “Pressure Ulcers in Long-Term Care,” suggests that these strategies for prevention go hand-in-hand with those for treatment of already existing ulcers. For example, it has been shown that frequent repositioning of patients who are bed or wheelchair bound and teaching patients who are prone to inactivity to shift weight and self-reposition are helpful. Other preventive measures include keeping the skin clean and dry, preventing excessive moisture resulting from incontinence, and use of nutritional supplements to maintain good nutrition. For residents who are especially at high risk of developing pressure ulcers, pressure-relieving/reducing cushions or mattresses should be used based on individual needs, comfort, and the cost of the device.
The article emphasizes that the optimal management of pressure ulcers requires understanding of differential diagnosis of chronic wounds and the use of standardized assessment metrics to both recognize and treat pressure ulcers with a systematic approach. It also emphasizes that nursing homes must take precautionary steps toward providing care for conditions that increase a patient’s risk of developing pressure ulcers, including incontinence and malnutrition. The authors conclude that “nothing can replace good personal attendant care with frequent turning, lifting, and transfers that minimize friction and shear.” Therefore, the study once again confirms that adequate staffing of skilled nursing facilities is crucial to carrying out individualized care plans addressing each resident’s specific medical and functional problems.
It has been shown that adequate staffing levels can help reduce the incidence of pressure ulcers in long-term care facilities. In the National Pressure Ulcer Long-Term Care Study more than 0.25 hours per resident per day of registered nurse time and more than 2 hours per resident per day of nurse’s aide time were associated with a lower risk of developing pressure ulcers. The same study showed that a lower than 25% licensed practice nurse turnover in a given facility was associated with better outcomes.
Pressure ulcers are preventable and thus their development is often used as a quality indicator for nursing homes. Residents and families can choose a nursing home by looking at its published incidence and prevalence rates of pressure ulcers at Nursing Home Compare. Statutory standards of care for long-term care facilities under California Health and Safety Code Sections 1276.5 and 1599.1 also make it easier to prove that a nursing home is responsible for allowing a pressure sore to develop.
If your loved one is at high risk of acquiring pressure ulcers and he or she is not receiving proper care, contact us today so that we can help protect your loved one’s best interests and hold the responsible parties accountable.