Untreated Pressure Injury- A Common Problem in Nursing Homes

NPUAP Stage 3 Pressure Injury with Epibole – Example of Untreated Pressure Injury Ulcer

Upon admission to a nursing home a resident should have a full body skin assessment where they are looking for any open areas, cuts, scratches, rashes or other skin risk issues.   There is often a Braden Scale evaluation made where the residents skin breakdown risk is assessed numerically where it can then be objectively monitored.  An untreated pressure injury/ bedsore/pressure ulcer/pressure sore can rapidly worsen to the next stage very quickly.  Especially if the aggravating factors that lead to the pressure ulcer continues.

Information on Untreated Bedsore/Pressure Ulcer/Pressure Sore

One valuable resource for information about untreated bedsore/pressure ulcer/pressure sores is the National Pressure Ulcer Advisory Panel – NPUAP the site offers information about the stages of pressure sores and way to prevent and treat the wounds.

According to NPUAP there are the following stages of pressure ulcer wounds:

Untreated Pressure Injury – Pressure Ulcer Stages/Categories

Category/Stage I: Non-blanchable erythema

Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Category I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons.

Category/Stage II: Partial thickness

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or sero-sanginous filled blister.Presents as a shiny or dry shallow ulcer without slough or bruising*. This category should not be used to describe skin tears, tape burns, incontinence associated dermatitis, maceration or excoriation.
*Bruising indicates deep tissue injury.

Category/Stage III: Full thickness skin loss

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. The depth of a Category/Stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and Category/Stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep Category/Stage III pressure ulcers. Bone/tendon is not visible or directly palpable.

Category/Stage IV: Full thickness tissue loss

Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often includes undermining and tunneling. The depth of a Category/Stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and these ulcers can be shallow. Category/Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis likely to occur. Exposed bone/muscle is visible or directly palpable.

Report Suspected Abuse and Neglect – Untreated Pressure Injury

For more information from the Minnesota Department of Health, Office of Health Facility Complaints concerning nursing homes, assisted living and other elder care providers view resolved complaints at the MDH website.

If you have concerns about untreated pressure injury or any other form of elder abuse or neglect contact Minnesota Elder Abuse Attorney Kenneth LaBore toll free at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

Disclaimer