Stage 3 bed sores

[billysboy]

My Dad has been in hospital since xmas and I thought I was going to lose him at one point however he has fought on and has made a remarkable recovery
After week one he was identified as having bedsores on his back and on his feet which despite an air mattress have got worse and the one on his behind is now 6 x 7 cm and classed as a stage 3 and the two on his heels are both stage 2

I sat there for 3 hours the other day and un interrupted by any nursing and it occurred to me on the way home he hadnt been turned or moved by nurses

When I got back I called the ward and spoke to the nurse in charge of his care , it has been recommended that he stand during the day to help this I think they all seem to rely on the air mattress to work its magic

I have googled about the bed sores and I am very concerned has anyone else had any experience with this and the healing of these ?

Hi community nurse here.
I look after lots of people with pressure ulcers, and bottom and heels are very common places for them to develop.
It's good that you dad is on an airwaves mattress, but his heels really ought to be offloaded too, either with a pillow under his ankles or with special boots.
I would also expect the nursing staff to be encouraging him to turn frequently in the bed, and walk around if he is up to it.
Hope he gets better soon :)

Ideally they should be offloading his sacrum as well if its a grade 3 , so minimal time sitting/lying on his bottom , such as meals times only.
Usually a grade 3 will have to be referred to the tissue viability nurse who will prescribe treatment and look at his diet and the routine of position changes he has.
There should be a position chart documenting his positions , if he's improving enough to stand then I'm sure he'll improve quickly . Good nourishment , offloading and the correct dressings will all help.

Sorry just realised you said back not bottom , ignore sacral stuff then. Is it difficult for him to sit or lie without pressure going on that area?

It is on his sacrum he has had a pump fitted but is left sitting in his chair for hours
His nutrution isnt great especially when they forgot his lunch yesterday

My concern is infection and will it heal

Make sure a dietitian is involved in his care also. An extra 500 calories a day is required for wound healing.

There are great dressings for pressure injuries like this , they do heal.
Nourishment is important , can you encourage him with nutritious snacks , the supplements they give in hospital aren't appealing at all and loads of patients can't drink them.
Encourage him to stand up when you're visiting , any relief is good to get that blood flow back. Ask someone to assist you if he needs help.
Air flow mattresses and cushions are good but if someone is thin and ill they don't completely prevent .
Is he continent? Are you worried about infection in that way?

We normally do 2-4 hourly pressure relief so he could have been moved just before and just after.

He is down to 8 stone from 11 before xmas and 80 yo I have been taking in chocolate, cheese crisps anything that he will eat as he has no appetite he gets indegestion if he eats
He has recently undergone colon cancer surgery and has a stoma bag
I am going to take in some chicken soup tomorrow in a flask
there is a nutritionist , physio and specialist with the sores however it says on his sheet to stand every hour but no one comes in or gets him to stand when I am there so I dread to think what happens if I am not there

Sounds like they're doing everything they can , maybe if you're there they don't want to disturb your visit , you could instigate the standing to ensure it gets done.

Don’t want to scare you by no means
Dfil was in care home with Alzheimer’s, whilst in there he got heel sores on both heels. The next thing he had one on his side/bottom, I think it’s because he was left there for hours not being moved in a chair.
These got worse and he was admitted to hospital, it was only whilst he was in there that we learnt the extent of them!
They turned unstageable, I asked the nurse and she said it’s when they have gone through the flesh into the bone and are black and smell.
I was disgusted how a care home could let this happen, I know there under staffed but to let this happen to a human being just to let them sit there for hours in a chair. There’s no way I’m going in a home, no way

Just you make sure you are heard, even if they think your a nuisance
Do it. Check his chart to see when he as been changed around.
Pillows for his heels and back. Ask if he’s on antibiotics or needs them
Basically keep a vigil eye on things, don’t take anything for granted
He’s in hospital, best care etc. They havnt the time.

My dfil ended up in so much pain.

Hi, I'm so sorry to hear you're going through the mill with your father, you have all our sympathies. Regular turning and nutrition are important but what he is laying on is also very important. There is a study going on in NHS Scotland atm which is questioning the effectiveness of alt. air mattresses for pressure care and there is a rumour they are actually causing them. There is a new overlay on the market (Treat Eezi) which not only allows air to be circulated underneath (stopping sweating etc) but its kinder to the skin. Clinical trials show it is helping heal up to stage 4 sores and patients express they are much more comfortable with it. Its new on the market but is becoming widely popular as an alternative. Worth an investigation

Hi, I'm so sorry to hear you're going through the mill with your father, you have all our sympathies. Regular turning and nutrition are important but what he is laying on is also very important. There is a study going on in NHS Scotland atm which is questioning the effectiveness of alt. air mattresses for pressure care and there is a rumour they are actually causing them. There is a new overlay on the market (Treat Eezi) which not only allows air to be circulated underneath (stopping sweating etc) but its kinder to the skin. Clinical trials show it is helping heal up to stage 4 sores and patients express they are much more comfortable with it. Its new on the market but is becoming widely popular as an alternative. Worth an investigation

Have the tissue viability nursed provided a plan for him? Can you ask to see it?
A pressure sore should already have been reported as an incident.

Have of this OP

vulcansilver.blogspot.co.uk/p/testimonials.html?m=1

Have a read of this. Autocorrect!

It's really unusual to get grade 3 pressure injuries in hospital having said that, I'm surprised the hospital has not pulled out all the stops to help heal this.

For me as ward sister we would have done an incident report and subsequent root cause analysis to identify how this had happened. Matrons, nurse specialist and dieticians would be involved and care of your DF would be strictly monitored.

You have had some great advice re helping to heal the injury going forward, I would kindly suggest you speak to the sister before PALS, the sister will be aware of your DF and his plan of care. If you find this takes you no further defiantly speak to PALS they are amazing.
Good luck with this I hope you see some improvements.

Out of interest what is your DFs mobility like?

Thanks for all the replies

His mobility is not great last Sunday I got him up on his frame and we walked 50ft up the corridor but if I am not there I am not sure he gets the time with the physio
I talked to the Sister and emailed her as well
Called Dad this morning he said he had his cooked breakfast but the lady put it on his table he then called the nurse on the button who turned up to cut it up by which time it had gone cold !!! so he didnt fancy all of it and left over half
I am going back in there tomorrow to ask some more questions !

I am gutted without the bedsores he could be in a physio unit and on track to get home

Sounds like you are doing the right things. Your father should be being re positioned regularly, be assessed by a dietitian to ensure his nutrition is optimal, and his pressure wounds need to be kept clean. Supporting him to mobilise is also important. If he has lost all that weight it sounds like the team are not on top of his nutritional situation. Developing grade 3 pressure sores while in hospital is a serious thing, the ward should be taking this seriously and making every effort to get them healed.

Here are some links to guidelines/standards on pressure ulcer care:
www.nice.org.uk/guidance/cg179/chapter/1-Recommendations#management-adults
www.epuap.org/wp-content/uploads/2016/10/quick-reference-guide-digital-npuap-epuap-pppia-jan2016.pdf