The prevention of bed sores is one of the great tasks that the nursing home staff must discharge. Bed sores have a serious adverse effect on the health and well-being of nursing home residents. Pressure sores can progress to Stage IV where muscle and bone are exposed. When this happens, it sets the stage for skin infections like cellulitis and bone infections like osteomyelitis which can easily result in the wrongful death of the nursing home resident.
There are three well-known risk factors for developing bed sores: immobility, incontinence, and poor nutritional status. These are among the factors incorporated into the Braden Scale, a tool frequently used by nursing homes to assess risk of developing bed sores as part of the care planning process.
How does incontinence contribute to the development of bed sores? Whether it is of bowel or bladder, incontinence serves to contribute to the breakdown of skin in two ways. First it keeps the skin moist. Second, the chemicals in urine and feces act to breakdown the skin itself. These are facts that are well-recognized in the nursing home industry.
Since incontinence increases the risk of developing bed sores, reducing a nursing home resident’s exposure to incontinence should serve to reduce the risk of developing bed sores – and that is where the use of a toileting schedule comes into play.
There are two parts to developing a toileting schedule. The first step is performing what is called a bowel and bladder assessment. During this, aides track when and how the resident goes to the bathroom over a period of several days to try to see if there are recognizable patterns. Once the patterns are identified, the schedule is put into place so that aides know to take a resident to the bathroom during those times of day when the assessment indicates that they are most likely to need to go to the bathroom. When correctly implemented, the resident should have fewer episodes of incontinence and therefore less exposure to urine and feces which damages the skin.
The difficulty with accomplishing this is that it takes considerable diligence on the part of the nursing home staff to get this done right. The assessment takes several days of regular observation and once in place, it must be followed day after day. Nonetheless, it offers an opportunity to address one of the more troubling factors which places residents at risk for developing bed sores.