Pressure Ulcers (Sores)

A pressure ulcer (sore) is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. Pressure ulcers (sores) can range from a small bruise to a gaping hole in the skin which goes all the way down to the bone. Pressure ulcers commonly occur in elderly people who are immobile or have limited mobility.

Pressure ulcers (sores) are categorized by staging. Generally, a Stage I is a redness without skin loss. A Stage II is a blistering involving partial skin loss. A Stage III is a full thickness skin loss without exposure to the bone. A Stage IV is a full thickness skin loss with exposed bone which many times has necrotic tissue. There are also unstageable ulcers where the base of the ulcer is covered with scabs, crusting and necrotic tissue which must be removed before staging is possible. Pressure ulcers (sores) should not develop if proper care is given. OBRA provides that “A resident who enters a facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable.” In order to be deemed unavoidable, the facility must show that the resident developed a pressure ulcer even though the facility took all necessary steps in evaluating the resident’s clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with resident needs, goals and recognized standards of practice; monitored and evaluated the impact of interventions and revised interventions as appropriate. Most pressure ulcers (sores) are avoidable and are caused by negligent care and treatment such as failure to turn the resident, keeping the resident in soiled clothing, not providing proper elevation and air mattresses etc.