IDPH has cited and fined Lexington of Orland Park nursing home after a resident there was found with a Stage 4 bed sore on her sacrum.
Bed sores are an area of intense focus in the long-term care industry for a number of reasons, not the least of which is that the development of bed sores has serious adverse consequences for the quality of life of a resident who suffers one. Federal regulations provide that a resident who enters a nursing home without a bed sore (or pressure ulcer) should receive care, treatment, and services necessary to prevent one from occurring unless the resident’s condition shows that they are unavoidable. The regulations also provide that after a resident develops a bed sore, they are entitled to care, treatment, and services which are necessary to promote healing, prevent infection, and prevent the development of new pressure ulcers.
It is an area which is specifically addressed during the care planning process. It begins with an assessment of the resident, usually using the Braden scale to determine the resident’s risk level of developing pressure ulcers. There are a number of risk factors, but they key risk factors are immobility, incontinence of bowel or bladder, and poor nutritional status. If a resident is at risk for developing bed sores, this must be addressed in the resident care plan with steps that should be taken on a day-to-day, shift-to-shift basis. If a resident does develop a bed sore or has a decline in an existing one, this is something that requires physician notification and revision of the care plan.
The resident at issue was admitted for short terms rehab after a fall in which she suffered a broken back with no bed sores present. However, she was at risk for developing bed sores due to immobility associated with the fractures and incontinence of bowel and bladder. The care plan which was put into place including daily monitoring of the skin. Usually this is a task which is done by the aides which assisting a resident with getting dressed, bathing, or providing incontinence care. If an aide sees an area of concern, it is the aide’s responsibility to notify the nurse who can then make a determination what it is and notify the doctor if need be.
Bed sores or pressure ulcers are rated as Stage 1 through Stage 4. A Stage 4 is the most severe, involving exposed muscle and bone. However, advancing from a Stage 1 to a Stage 4 takes time, and treatment can and should slow the progression, if not actually heal the wound once it is discovered. This is why physician notification is required after a resident is discovered to have a bed sore. Without treatment, further decline is almost a certainty.
When the staff first reported that this resident had a bed sore, it was a Stage 4 bed sore on her sacrum with sloughing and exposed bone. In other words, this was an advanced wound, and the presence of sloughing is often associated with dead, bacteria-laden tissues which can set the resident up for complications such as cellulitis or osteomyelitis infections. The resident was referred to a wound care doctor for treatment.
The fact that this wound was so advanced when it was first documented says that one of a number of things, but either the aides did not realize that this was a resident for whom daily skin inspections was required; they did not realize what they were looking at when they were dressing, showering, or providing incontinence care to the resident; or they did not know that skin defects needed to be reported to the nursing staff. None of these reflect well on the quality of care that was being provided at this nursing home.
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