Bedsores and Ulcers
By: Attorney, Andrew M. Rockman
Patients who are bedridden for significant period are often at risk for decubitous ulcers, better known as bedsores. This is a known problem, and requires the integrity of the skin to be closely monitored. While lying in bed, moisture and the breakdown of the skin can occur if there is inadequate, movement or skincare. It is known that the patient must be adequately moved and the skin examined to make sure that there is no breakdown in those areas where there might be skin irritation or retained moisture that is not adequately monitored and corrected. This is especially so in the elderly who are often unable to change positions and whose skin are more susceptible to the effects of unrelieved moisture or friction. There are known equipment and maneuvers that significantly reduce the occurrence of these bedsores. Patients with conditions that impact circulation, such as diabetes are also at risk for skin breakdown arising from circulation problems, unrelieved pressure on the skin and prolonged exposure to moisture.
Despite the frequent defense that it was age, the nature of the original illness or circulation problems that made the ulcer inevitable, medicine knows that these conditions can be prevented if there is adequate attention paid to the skin and to all those risk factors that make skin vulnerable.
Redness on the skin or long periods of immobility either in a bed or in a wheel chair, are known alerts to any attentive nurse and/or doctor that the patient is at risk for ulceration of the irritated and fragile skin. The care takers must be required to not only move the patient repeatedly but to monitor those parts of the body that are most frequently immobile or in contact that an object that can cause irritation, retained moisture, or a situation where skin breakdown is most likely to occur.
Simply stated pressure ulcers should not just be discovered at a late state of development and should not be permitted to progress when there are alerts or warnings that must be continuously checked by the caretaker. A key is to determine what the medical records or charts show as to the monitoring of the patient’s skin, its care and the need to change both positioning and bed clothing to reduce irritants. There must be clear evidence and documentation in the chart confirming that the patient has been properly monitored and areas of skin abnormalities noted and corrected.
Allowing a patient to remain seated or in bed for prolonged periods, without repeated turning, or repositioning is a known departure from the standard of care. Dramatic skin eruption or ulceration not previously observed is also an indication that the required monitoring and observation has not been provided.
Any family who has a person in prolonged care is well advised to make sure the patient is continuously monitored and moved. They must make sure that medical history or any health factors that might make a particular patient more susceptible to skin breakdown are known. These would include diabetes, circulatory problems, age, incontinence, or any previous history of skin breakdown. It is often very helpful for a family to be paying close attention to what is going on for an immobilized patient, so that inadequate staffing and monitoring does not threaten the health of the patients skin or invite ulceration.
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About the Author
Attorney Andrew M. Rockman, chairs the Medical Malpractice Department at the Princeton-based law firm of Pellettieri, Rabstein & Altman and has earned an “AV” rating by the Martindale-Hubbell Law Directory.
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