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Quick Tip for Families in Intensive Care:  Does Lack of Turning & Wound Care for an ICU Patient Contribute to Worsening of Stage 4 Bedsores & Decline?

A lack of turning and wound care for a critically ill patient in intensive care contribute significantly to the worsening of level 4 bed sores and overall decline? That’s a question that we have from one of our clients.

Hi, my name is Patrik Hutzel from intensivecarehotline.com and this is another quick tip for families in intensive care.

Today, I have a question from one of our clients as part of a medical record review we’ve done for them, and I’m going to answer that question today.

Does lack of turning and wound care for a critically ill patient in intensive care contribute significantly to the worsening of level 4 bed sores and overall decline? In short, yes, a lack of turning and proper wound care in an ICU setting absolutely contributes significantly to the worsening of level 4 bed sores and overall patient decline, and it’s considered a serious lapse in standard critical care, and here is why.

Level 4 bed sores are really medical emergencies. Those involve full thickness tissue loss with exposure of muscle, bone, or tendons. In an ICU where patients are often immobile and critically ill, turning every 2 hours is absolutely essential to prevent and manage pressure injuries. Immobile ICU patients are at extreme risk for pressure ulcers. Not turning them allows constant pressure over bony areas, impairing blood flow and causing rapid tissue death, especially in those with poor nutrition or perfusion. A lot of patients in ICU have poor perfusion because they’re often on high doses of inotropes or vasopressors  constricting perfusion.

Next, of course, infection risk. Level 4 ulcers can easily become infected leading to sepsis, a life-threatening systemic infection, osteomyelitis, a bone infection, fistulas, or tunneling wounds. Without routine wound cleaning, dressing changes, and infection control, the wound deteriorates fast, and the patient deteriorates fast. Prevention is better than cure, preventing pressure sources is really what’s important because wound care is a core ICU standard.

ICU protocols demand rigorous skin assessments, turning schedules, and wound management. Neglecting these can accelerate decline through infection, pain, and stress responses, fluid electrolyte imbalances, increased metabolic demands in a fragile patient, and of course, overall decline.

Patients in ICU are so fragile and vulnerable. They don’t need pressure sores to contribute to their already difficult clinical situation. Because these wounds drain energy, nutrients, and immune capacity from the body, combined with other ICU complications like ventilator use or infections, inotropes, vasopressors, often dialysis. Untreated bed sores can be a major factor in multi-system decline and death.

Obviously, this is very serious, and you need to raise this with, the ICU team. You need to raise it with hospital executive, patient advocates like you have done with us here at intensivecarehotline.com. But you cannot let things like that slide, it’s too serious, and that’s why I’m saying you need help from Day 1 when you have a loved one critically ill in intensive care.

In our specific client question, the patient was consistently immobile throughout the ICU stay and the Braden Score was consistently documented as 8, categorizing the patient at very high risk for skin breakdown. During the stay of the patient in ICU, the wounds failed to show signs of healing with notations describing bone exposure, no granulation tissue, continuous drainage, and deterioration rather than improvement.

In high risk patients, the standard of care requires not only turning to be ordered too hourly. But that it be performed, tracked and evaluated for effectiveness, i.e., check the skin. The absence of routine and traceable implementation of these interventions suggests a breakdown in both preventive and responsive wound care.

Standard orders for repositioning every 2 hours and the use of low air loss alternating pressure mattress were present.  There were documentation verifying that these reposition protocols were executed in our client’s case. However, the presence of worsening wounds, despite preventative orders, raises concerns about whether repositioning and pressure offloading were actually performed as frequently or effectively as recorded.

There were no significant wound healing interventions beyond basic dressing changes, i.e. optimum goals are documented. There’s no evidence of advanced wound therapy such as negative pressure wound therapy, surgical debridement, or hyperbaric oxygen therapy being employed or pursued.

Clinical notes also describe continued severe malnutrition and hypoalbuminemia. Albuminemia, which means a low albumin, both of which impair wound healing and heighten the importance of pressure relief strategies. The patient’s overall decline, including persistent infection, nutritional failure, and multi-system deterioration correlates temporarily with the failure of wound healing.

Failure to implement adequate repositioning and escalating wound care strategies in a patient with stage 4 ulcers and systemic decline meets the threshold for contributory harm particularly when there is no evidence of wound improvement and no documented reassessment of current care effectiveness.

Combination of immobility, sepsis risk, low albumin, and lack of effective turning creates a high risk profile in the environment that requires more aggressive multidisciplinary intervention. Like I said in my one of my last videos, the pressure I saw is a never event, lack of potential and effective turning, incomplete wound management and failure to escalate care contributed significantly to the worsening of the patient’s pressure injuries and likely accelerated the clinical decline.

I hope that answers your question.

Now, I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years. I have been consulting and advocating for families in intensive care all over the world since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients with our consulting and advocacy. You can verify that on our testimonial section  at intensivecarehotline.com. You can click on the testimonial link, or you can go to our intensivecarehotline.com podcast where we have done client interviews, detailing and verifying everything that I’m saying here. You can go to intensivecarehotline.com and you can click on our podcast link to watch the interviews there.

Because our advice is absolutely life changing, and I mean that in every positive sense. It’s absolutely life changing because we have saved so many lives for our clients in intensive care over the years and we have improved our clients’ lives instantly so that our clients can make informed decisions, have peace of mind, control, power and influence, making sure their loved ones get the best care and treatment always. You can join a growing number of members and clients that we have helped over the years.

That’s why I do one on one consulting and advocacy over the phone, Zoom, Skype, WhatsApp. Whichever medium works best for you. And I talk to you and your families directly. I handled you through this once in a lifetime situation that you simply can’t afford to get wrong. I also talk to doctors and nurses directly or the case managers, whoever you want me to talk to, and I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. You will see the dynamics shift very quickly once you know what questions to ask, once you have someone talk to the doctors and nurses directly  who understand intensive care inside out just as they do.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, where you have access to me and my team, 24 hours a day, in the membership area and via email. We answer all questions intensive care related in the membership. You can get access to the membership if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I’ve personally written and recorded. All of that will help you, once again, to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to support at [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Like the video, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.

I also do weekly YouTube live where I answer your questions live on a show, and you will get notification for the YouTube Live if you’re a subscriber to my YouTube channel, or if you’re a subscriber to my intensivecarehotline.com email newsletter.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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