It is all too unfortunate how frequently bed sores are reported in nursing homes. However, bed sores are a clear indication of nursing home abuse and/or neglect, and should be reported to the appropriate authorities. Upon discovery of a bedsore, the wound should be immediately classified so that the proper treatment can be administered. However, on occasion, the extent of the wound upon discovery is so advanced or severe that it cannot be immediately classified. There may be necrotic tissue covering the wound, a raging infection, inflammation, pus, weeping, bleeding, urine or fecal matter in the wound, and/or foreign debris in the wound site, making it very hard to determine the depth of the wound and damage that has been sustained. These wounds are temporarily classified as “unstageable bed sores” or “unstageable pressure ulcers.”
Summary of Bed Sore Stages I-IV
As previously discussed in an earlier blog post on the topic, bed sores or pressure ulcers are usually classified in four stages. To summarize, stage I bed sores are usually red, warm to the touch, and irritated, but will go away if the pressure on the wound site is relieved. Stage II bed sores are usually identified by the existence of a shallow open wound, blister, or abrasion that will heal relatively quickly if treated immediately. Stage III bed sores are painful, extend into the muscle tissue, and take a long time to heal. Stage IV sores are very deep and may affect the bone, deep muscle tissue, and even tendons and joints. Stage IV bed sores can be fatal if not treated immediately. However, it is sometimes difficult for nursing staff to accurately distinguish between a stage II, III and IV pressure ulcer, and it is very important to be able to analyze the full depth and extent of the wound before administering treatment. Misdiagnosis of an ulcer can lead to improper treatment or prevention, and can lead to health complications.
Unstageable Bed Sores
An unstageable bedsore is a classification used to describe an ulcer having full thickness tissue loss, in which the base of the ulcer cannot be seen, and thus the depth of the wound. This is usually because the wound bed is covered by slough or eschar.
Slough is necrotic tissue that is in the process of separating from viable, living tissue, and is usually yellow, tan, green, brown, or gray in color. Eschar is a type of slough that is the result of a thermal burn, chemical burn, or the result of gangrene, which is common in diabetic ulcers. Eschar is normally tan, brown, or black in appearance, and normally forms around the edges of an ulcer or ulcer-like wound. Some eschar is good; for example, stable eschar that is dry, intact and, adherent on the heels of a diabetic individual is a biological protective barrier and should not be removed.
An ulcer may be categorized as unstageable until enough of the slough and/or eschar is removed from the wound to expose the base and depth of the ulcer. After the wound is cleared, and a full assessment of the wound can be conducted and a proper classification assigned, treatment of the wound can begin.
If your loved one has suffered from a bedsore while residing in a nursing care facility, or you have been informed that your loved one is suffering from a bedsore, please do not hesitate to contact our Nursing Home Abuse and Neglect Law Firm online or at 877-356-3007.
J. Black, et al., National Pressure Ulcer Advisory Panel’s Updated Pressure Ulcer Staging System: Unstageable Pressure Ulcers, Urologic Nursing, 2007; 27(2): pages 144-150.