December 2015 | Wesley Hospice

Management of Pressure Ulcers

Pressure ulcers are also known as bedsores. They are not uncommon for people who spend hours either lying in a bed or sitting in a wheelchair for long periods of time with little or no movement. Pressure ulcers are caused by sustained pressure being placed on a particular part of the body.

Blood contains oxygen and other nutrients that are needed to help keep tissue healthy. Without a constant blood supply, tissue is damaged and will eventually die. The lack of blood supply also means that the skin no longer receives infection-fighting white blood cells. Once an ulcer has developed, bacteria can also infect it.

People who are able to maintain normal mobility do not develop pressure ulcers as their bodies make several regular movements that prevent pressure from building up on any parts of their body. For example, you may think that you are lying still as you sleep, when in reality you may shift positions up to 20 times a night.

Pressure ulcers can be caused by:

  • Constant and unrelieved pressure that damages the skin and underlying tissue due to lack of mobility and blood circulation. Common pressure points on the body include the tailbone, hipbone areas, ankle and heel.
  • Pressure sores may also result from friction caused by your skin rubbing against another surface, or when two layers of skin slide on each other, moving in opposite directions and causing damage to underlying tissue.
  • Excessive moisture that softens your skin and reduces its resistance can also cause pressure sores. This can occur with excessive perspiration and with urinary or fecal incontinence.

All of the factors listed below place you at higher risk for pressure ulcers:

  • Immobility
  • Inactivity
  • Fecal or urinary incontinence
  • Poor nutrition
  • Decreased level of consciousness
  • Low body weight
  • Smoking

Medical conditions such as the following also put you at risk:

  • Anemia
  • Infections
  • Edema
  • Diabetes mellitus
  • Stroke
  • Dementia
  • Alcoholism
  • Fractures
  • Cancer malignancies

The best ways to prevent pressure ulcers (bedsores) are by moving around frequently to avoid pressure against your body and by redistributing your body weight to promote blood flow to the tissues. If you already have a pressure ulcer, it should be assessed by a qualified healthcare professional.  You will likely be asked to have a tracing or a photo taken of the area so that it can be monitored to determine your response to treatment.

For pressure ulcers to heal, you need to change your position as much as possible. Relieving and spreading out pressure is the most important part of preventing and treating pressure ulcers. Pressure can be relieved several ways, often with a combination of the below treatment:

  • Change positions at least every 2 hours if you are confined to a bed. Change as often as every 15 minutes if you are in a wheelchair.
  • Avoid sliding, slipping or slumping, or being in positions that put pressure directly on an existing pressure sore. Try to keep the head up while in bed, a recliner chair, or a reclining wheelchair raised no more than 30 degrees. Recliner chairs are more likely to allow slipping. They should not be used in place of a bed.
  • Use special support surfaces. There are mattresses, bed covers and chair cushions designed to help reduce and spread pressure. Other products, such as doughnut-type devices, may actually cause pressure sores. Talk to your doctor about what products would be best for you and where to buy them.
  • Work with your doctor to be sure there is no pressure on your skin or that there is good padding between your skin and other surfaces.

Before starting any treatment for pressure ulcers, check with your doctor, or if you or your loved one is working with a hospice team, a member of that team can assist in getting the proper treatment started to assure proper care including pain management.

What is an Interdisciplinary Team? (IDG)

Hospice uses a team approach to providing care. Hospice services are governed by what is called an interdisciplinary group (IDG). The first part of the team consists of the patient and members of their family who help make decisions regarding the plan of care. The remaining members of the hospice IDG team consist of highly qualified, specially trained hospice professionals, including physicians, nurses, social workers, and Chaplain/Spiritual Counselors. Other members of the team who may be present during IDG meetings include State Tested Nursing Aides (STNAs), therapists, community relations personnel, volunteer coordinators and trained volunteers. Each professional provides services according to their specific field of expertise by visiting with the patient and their family, and in some cases may provide services from the hospice offices.

Along with the services provided by the IDG team, the hospice benefit also provides all medicines, equipment, treatments and supplies needed to manage the symptoms of the terminal illness keeping the patient comfortable. They also help your loved ones cope during this transition.

Each member of the team must have a minimum education regarding:

  1. Purpose and focus of hospice care
  2. Team function and responsibility
  3. Communication skills
  4. Introduction to and review of physical, psychosocial, and spiritual    assessment and symptom management
  5. Review of universal precautions
  6. Patient and family safety issues
  7. Consistent with applicable laws and regulations
  8. Stress management
  9. Grief and Bereavement
  10. Confidentiality and patient rights

All members of the hospice IDG team recognize and accept a fiduciary relationship with the patient and family, maintaining professional boundaries with the patient and family, and understand that it is the sole responsibility of IDG team members to maintain appropriate agency and patient-family relationships.

For further information regarding hospice, the interdisciplinary team or how we can help your family with hospice needs, please call Kenya Y. George at (614) 451-6700 or email her at