Don was newly retired at the age of 65 and looking forward to traveling with his wife Elaine. Then a series of medical problems landed him in the hospital. He deteriorated rapidly and became so weak that he was unable even to lift his head off the pillow. Many years later his wife, Elaine, recalled, "They told me he was going to die."
One day about a month after Don arrived at the hospital, there was a sudden flurry of activity, and he was moved to a gorgeous corner room that he had all to himself.
The new room was large enough that Elaine could stay when Don was being treated. She said, "I peeked through the curtain while they were turning him and I saw the bedsore on his lower back. It was four inches long and I could see down to his bone. Then I find out that he's got them all over. He had four of them."
Bedsores are also known as pressure ulcers or decubitus ulcers. Don's were all Stage IV, the worst possible. It means that much of the tissue from the skin down to the bone has been damaged or even has died.
Bedsores develop because of unrelieved pressure on bony parts of the body when an individual stays in one position for hours at a time, as Don did because he was too weak to move. They also arise from friction or shear when a patient slips out of position or drags himself in bed -- or is dragged by caregivers -- instead of being lifted.
Most experts agree that bedsores can start to develop in as little as two hours. Drew Griffin, a certified wound care nurse with 18 years of experience, observes that if the patient is at high risk -- due to factors including immobility, other medical problems, poor nutrition, and dehydration -- it can take even less time.
The Mayo Clinic reports that even Stage I and Stage II pressure ulcers can take months to heal. Stage III and Stage IV pressure ulcers may never heal. As Elaine pointed out, "The skin may grow over it, but you're missing the muscles and tendons and nerves. All that tissue that was destroyed and had to be removed because it was dead never comes back."
After Don had been in the hospital for nearly three months, they finally diagnosed and addressed the illness that had put him there. He was soon well enough to be discharged to a rehabilitation facility. A month later, he was sent home. However, he still had four Stage IV bedsores.
For six months, nurses including Kate Suchmann, R.N., came twice a day seven days a week to change his bandages and clean the wounds. Toward the end of that time, Suchmann trained Elaine to do much of this critical, painstaking work.
Now a professor of nursing at Vermont Technical College, Suchmann commented, "Elaine is very probably the only reason he's alive. She is very gifted, focused and precise - and she was always asking questions."
For years, Don's and Elaine's lives revolved around dealing with his bedsores. And Don is not alone in his experience.
According to HealthGrades, 189,315 Medicare patients developed pressure ulcers as a result of hospital care in 2008, and those bedsores were the cause of death for 17,611 of them.
Griffin, the certified wound care nurse, noted, "Pressure ulcers are preventable 100 percent of the time." Medicare, the federal health insurance program for the elderly and disabled, agrees.
Medicare calls pressure ulcers "never events," meaning that they are so preventable that they should never happen. In fact, Medicare typically won't reimburse hospitals for treating bedsores, because the hospitals should have prevented them in the first place.
Today, more than 10 years later, Don is still suffering. He said recently, "I have tremendous pain." Elaine rattled off a list of medicines Don takes to treat the pain and the nerve damage.
If you or a family member or friend is in the hospital, what can you do to avoid an experience like Don's?
- Learn about the risk. Go to www.bradenscale.com. Click on Products. Then click on "Braden Scale for Predicting Pressure Sore Risk." This one-page quiz is widely recognized as a useful tool to tell how likely it is that a specific patient will develop bedsores.
- Ask the patient's doctor to help you understand the patient's risk and to explain what the doctor and the hospital staff will do to prevent pressure ulcers from developing. For example, one critical step is to reposition patients every two hours if they are immobile.
- Ask what the patient and family can do to reduce the risk. Suchmann, the nursing professor, notes that when patients refuse to shift position and/or refuse to drink or to eat, they can dramatically increase their risk. "It's not their fault. When people don't feel well they often don't want to do these things. But the biggest risk for bedsores besides pressure is poor nutrition. And people don't want to drink enough fluids. Fluids are essential for tissue function. So patients need to move, drink, eat."
- Follow up to ensure that planned actions take place. Ask to see the results of assessments of the patient's skin. Check to make sure that the patient is in fact being repositioned. If you see that the patient is not eating or drinking, ask for an assessment by a dietician.