Non-Preventable Pressure Ulcers - Topic Discussed by Nursing Expert Expert Article

In this article, Registered Nurse and Nursing Home Administrator, Tiffanie Haemer discusses the topic of pressure ulcers (bed sores) and whether or not they can always be prevented within a health care setting.

Nursing Expert Witness

Can Pressure Ulcers Always Be Prevented?

Understanding the emotional drain on a family when their loved one’s skin integrity is compromised is always difficult. We all expect our parents to die at some point, as it is natural to our existence. Most of us have imagined what it would be like to live without the love and support of the people who took care of us when we could not. What most of us don’t think about is the process of death on the body.

Maintaining the skin integrity of someone who is actively dying can sometimes be impossible. The skin is the largest organ of our body and is the only organ that is outside of our body. As people are approaching the dying process they enter what is sometimes termed, “multi-organ failure”. This is where all of the organs, including the skin, begin to slow down and not work as efficiently. When organs don’t work efficiently, there is often times a lack of the much needed oxygen that is delivered through the blood. Without the necessary oxygen, our skin begins to breakdown over the bony prominences.

Types of Pressure Ulcers

A Kennedy Terminal Ulcer is a term used to describe a pressure ulcer that some people develop as they are dying. The Kennedy Terminal Ulcer is unique in that it can develop within a very short amount of time and can progress to a stage III or stage IV pressure ulcer within hours. It usually starts out as a blister or abrasion on the sacrum. This ulcer can be many different colors but is often described as having the shape of a pear.

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We treat a Kennedy Terminal Ulcer in the same way that we treat any other pressure ulcer with similar characteristics. The majority of these ulcers do not improve and are thought to be a terminal sign for the patient.

A pressure ulcer that is not considered to be a Kennedy Terminal Ulcer will also be found over a bony prominence but will typically be symmetrical in shape.

The 3:30 syndrome is another type of pressure ulcer that is considered unpreventable. This pressure ulcer presents a little differently, and in a much shorter time period. Usually appearing as small, black spots that are often mistaken for specs of dirt. The 3:30 syndrome is also mistaken for a deep tissue injury and is often described as having not been there earlier that day. These “specs of dirt” will progress very quickly, within a few hours, and will result in the death of the patient within 8-24 hours.

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When a pressure ulcer is not considered to be part of a terminal process or multi-organ failure, can it be unpreventable?

Yes, there are situations when a terminal illness or multi-organ failure has not been identified and a pressure ulcer can be determined to be unpreventable. The department of health identifies the measures or processes that a facility must undertake when a patient’s skin is at risk of developing a pressure ulcer. If the facility in question has assessed the patient, identified potential negative outcomes, implemented interventions, evaluated the effectiveness of those interventions, and then implemented new interventions repeatedly, and these measures fall within the standard of care guidelines, the pressure ulcer may be determined to be unpreventable.

The expectation is for the professionals to follow the standard of care but they cannot always prevent the development of a pressure ulcer. With the above mentioned ulcers, relieving the patient’s pain will often times become the priority.

Forensic Health Care Investigations

The health care experts at Robson Forensic can address the adequacy of care provided in hospitals, nursing homes and other acute, rehabilitation, long term, outpatient or residential health care facilities. The scope of our investigations will frequently involve an evaluation of administrative policies and procedures, the level of care provided by health care professionals, or the maintenance and custodial practices of care facilities.

For more information visit our Health Care practice page.

Featured Expert

Tiffanie L. Bova, Nursing Home Administrator & Health Care Expert

Tiffanie L. Bova, NHA, RN, WCC, DWC, RAC-CT

Nursing Home Administrator & Health Care Expert
Tiffanie Bova is a health care expert who is a nationally licensed Nursing Home Administrator, Registered Nurse, Wound Care Specialist, Diabetic Wound Care Specialist, and an expert in Resident… read more.


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