In this case, a man in his fifties, with no prior issue with immobility of skin integrity, was hospitalized while on pain medications and otherwise in and out of consciousness. One of the important things in a situation like this is that the patient must be routinely repositioned in order to avoid the development of pressure sores. This wasn’t timely done and the patient developed pressure sores.
Pressure sores, also called bed sores or pressure ulcers, occur when the skin breaks down from constant pressure, especially from sitting or lying in one position for any extended period of time. The pressure cuts off the blood supply to the underlying skin, fat, and muscle. These sores typically usually occur over bony prominences such as the tailbone, buttock, heel, shoulder blade, elbow, and occasionally the back of the head. However, pressure sores are not limited to these areas, and can occur other places as well.
Pressure sores are the fourth leading preventable medical error in the United States. Stage 3 and 4 pressure sores are listed as a “never event” by the Centers for Medicare and Medicaid Services. Never events are a series of medical errors that are defined as “clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility.”
Pressure sores begin as a relatively benign problem, but can quickly progress to a more serious problem if left untreated.
Stage 1 — A small area of warm, reddened or purpled skin that does not return to its natural color when pressed.
Stage 2 — The outer layer of skin breaks down. Blistering and swelling as well as warmth and redness may be seen.
Stage 3 — Live tissue dies. The sore extends down into the deep skin layers and to the fat and muscle immediately beneath the skin. This hole or crater has a foul smell.
Stage 4 — The sore extends down to the deep muscle, possibly down to the bone. Infection may occur and may tunnel under the skin, increasing the size of the sore.
Basic Prevention Methods Health Care Providers Often Disregard
- Regularly moving the patient at consistent intervals
- Preventing malnutrition and dehydration
- Making sure the patient remains dry and clean
- Using specialized cushions or mattresses to relieve pressure for a high-risk patient