Bed Sores in Nursing Homes
Barry: The development of a bedsore is something that represents a significant change in condition. In the nursing home industry significant change in condition is something that requires physician notification, and it requires revision of the care plan. When the doctor's notified, the doctors going to be giving orders for care for the wound. The care plan needs to be revised to reflect that all this additional care needs to be provided for the bedsore that exists, but also needs to reflect the fact the care plan that was in place to address the risk of developing a bedsore wasn't effective in preventing the bedsore from actually developing.
So there has to be a whole series of changes that are put into place.
Pam: And are there medical consequences to developing a bedsore?
Barry: There are all sorts of consequences to the development of bedsores. Probably the biggest one of these is increased susceptibility to developing infection. One of the functions that the skin serves is that it is a barrier for the entry of infecting organisms and when you have a bedsore, you have a breach in your skin integrity and that becomes an access point by which infecting organisms can go ahead and enter your body, and frequently what you'll see after a bedsore has occurred is that somebody's going to develop a Cellulitis infection, which is sort of a localized skin infection but those infections can go much deeper.
When somebody has a stage four bedsore, it's real common for somebody to develop and infection called Osteomyelitis, and basically what Osteomyelitis is, is it's a bone infection where the infection has set into the bone itself and the bacteria essentially eating away at living bone. One of the things that sometimes happens to try and treat bedsores is that a catheter will be put in so that urine is diverted into a bag away from the area that the bedsore is.
This is done where you have a bedsore on the buttocks, around the hips or on the tailbone and the problem with having a catheter put in is that it opens up the urinary tract and it leaves people susceptible to developing a urinary tract infection. It doesn't matter what kind of an infection you get, ultimately these are infections that need to be treated with antibiotics. Some of these are going to be more potent antibiotics than others but some of the antibiotics that are used to treat some the relatively low grade infections have an unfortunate side effect that's known as C.diff.
In your stomach there are all kinds of bacteria and they assist with the digestion of food and an antibiotic kills off bacteria within your body and the giving of an antibiotic can have the effect of killing off some of those bacteria that are in your stomach and cause all kinds of problems in terms of your digestive tract, and basically what C.diff is, is it's associated with loose watery stool, which soil the dressings and expose the already existing wounds to further contamination.
So many times you'll see sometimes multiple surgeries be done to address the issues with bedsores. You'll have wound debridement, which is basically cutting away of dead tissue within the wounds themselves but other times you'll see people have a colostomy in an effort to divert stool away from the pelvic area, sometimes you'll have people get a G-tube inserted to help with the nutritional issues that are involved.
All of these surgeries expose people to the risk associated with anesthesia and it really contributes to this horrible downward spiral that people tend to experience after getting significant bedsores.
Pam: So Barry, do people die as result of bedsores?
Barry: All too often, yes. Nursing homes often defend these claims by trying to say that the development of the bedsore was part of the dying process and that somebody died with the bedsore and not because of the bedsore, and the fact of the matter is, is that the most common scenario that I see in these kinds of cases is that somebody dies as a result of sepsis. They have an infection that's just completely out of control, it overwhelms them whether it's an infection that's brought on by Osteomyelitis or C.diff or a urinary tract infection or any number of other types of infections that people get.
Most often I see the infection as being something that's the immediate cause of death, and it's very closely associated with the development of the bedsore. Any which way you slice it, you need to get legal help when this kind of situation develops and you need help from somebody who has a good handle on some of the medical issues that are involved with these kinds of cases.