Pressure ulcer

What is a pressure ulcer?

A pressure ulcer, also called a bedsore, is localized damage to skin and underlying tissue resulting from sustained pressure, typically over a bony area of the body, that restricts adequate blood flow.

It develops when a person remains in one position for an extended period without adequate repositioning, which is precisely why these injuries are so strongly associated with inadequate nursing home and hospital care.

These injuries are staged by severity, ranging from early stage skin reddening through to the most severe stage involving deep tissue damage that can extend to muscle and bone.

Because they are largely preventable through proper, regular repositioning and adequate skin care, their development is frequently treated as strong evidence of inadequate care rather than being viewed as an unavoidable consequence of illness.

What are the recognized stages?

Severity is generally classified using a standardized staging system reflecting the actual depth of tissue damage.

• Stage 1, involving non-blanchable redness of intact skin
• Stage 2, involving partial thickness skin loss with a shallow open wound
• Stage 3, involving full thickness skin loss extending into subcutaneous tissue
• Stage 4, involving full thickness loss extending to muscle, tendon or bone
• Unstageable, where the actual depth cannot be determined due to obscuring tissue

Why are these injuries considered largely preventable?

Because established, well documented protocols exist for prevention, including regular repositioning schedules, appropriate support surfaces, and consistent skin assessment and care.

Facilities are generally required to assess each resident's specific risk level and implement an appropriately tailored prevention plan based on that individual assessment.

A pressure ulcer developing, or significantly worsening, during a facility stay is frequently treated as evidence that these established protocols were not actually followed as required.

How is a claim involving a pressure ulcer actually built?

Through the facility's own records, including risk assessments, actual repositioning logs, and skin assessment documentation, comparing what was genuinely required against what was actually documented as performed.

Photographic documentation of the wound at various stages, ideally taken consistently over time, helps establish the actual progression and severity.

Expert testimony from a wound care specialist can help establish whether the specific development or progression reflects a genuine departure from appropriate preventive care.

Staffing records are also frequently relevant, since inadequate staffing levels can directly explain why required repositioning was not consistently performed.

Common questions

Are pressure ulcers always caused by inadequate care?

Not automatically, though a significant number are genuinely preventable through proper care, and their development or serious worsening is often treated as meaningful evidence of a care deficiency.

What records should be requested in these cases?

Risk assessments, repositioning and turning logs, skin assessment documentation, and any relevant wound care treatment records and staffing schedules.

Can a pressure ulcer claim proceed alongside a broader neglect claim?

Yes, frequently. A pressure ulcer is often one specific manifestation within a broader pattern of inadequate care that a claim may address more comprehensively.