What to know about pressure injuries

Several common beliefs about bed sores are mistaken. One is that a small opening means a small wound. Pressure damage is often wider beneath the skin than at the surface, which is why clinicians measure depth and check under the edges.

Another is that rubbing a reddened area helps. Current guidance is to avoid massaging skin that already shows pressure damage. Ring or donut-shaped cushions are also a frequent mistake, because they can concentrate pressure around the edge of the ring. And a sore that does not hurt is not a mild one. Lack of pain may simply mean the person has lost feeling there. When in doubt, ask the treating clinician before trying a home remedy or a new cushion.

What an assessment covers

Part of every assessment is deciding whether the wound needs more than dressings and pressure relief. The treating clinician checks for signs of infection in the wound and the tissue around it, and looks for dead tissue that may be slowing progress. In a deep wound, the clinician considers whether bone could be involved.

Depending on what is found, the clinician may order lab work or imaging, or refer the person to a surgeon or another specialist. None of this is automatic. Each step is the clinician’s decision, based on the wound, the person’s health and the goals of care. Gateway helps arrange any orders or referrals that follow.

Pressure injury and bed sore care in the Central West End

In the Central West End, getting pressure-relief equipment into the home can be the hardest step. A hospital bed or specialty mattress may have to come up a narrow staircase or through a small elevator, and many families end up setting the bed in a first-floor living or dining room. Tell Gateway about stairs, entry codes and where a visiting clinician can park. We pass those details along when scheduling so the visit and any deliveries are planned around the building.

The Central West End wraps around the northeast corner of Forest Park, with Kingshighway and Euclid Avenue at its center and the Washington University Medical Campus on its doorstep. It is a dense, walkable part of St. Louis, a mix of high-rise apartments and historic houses on private streets, where students, professionals and retirees live side by side. Being close to hospitals does not make every appointment easy. For a person who is frail, recovering from surgery or living with a chronic wound, even a few blocks can be too far.

When care happens at home

Dressings are only part of what a pressure injury needs at home. The treating clinician may also order a pressure-redistributing mattress or overlay, a wheelchair cushion, heel protection or a hospital bed. Gateway follows up on those orders with suppliers and lets you know what to expect about delivery.

Dressings usually arrive in quantities meant to last until the next order. Check the box against what the clinician ordered, store it somewhere clean and dry, and tell us before the last few are used. Once equipment arrives, keep the instructions and the supplier’s phone number handy. Tell the clinician if a mattress feels flat, a cushion has shifted or the person will not tolerate it.

For residents of nursing and senior living communities

People often arrive at a rehabilitation center with a pressure injury that began in the hospital, or with fragile skin after surgery and days in bed. Therapy adds a new question: how long can the person sit in a wheelchair or on a mat without harming the wound? The treating clinician, nursing staff and therapists work that out together.

Rehab stays are short, so planning for what comes next begins early. Gateway can help arrange for wound care to continue after discharge, whether the person goes home or to another facility, so that orders, records and supplies follow them and care does not start over.

What to report and when to call 911

Pressure damage can start before the skin opens. Check the tailbone, hips, heels and other bony areas when you help with bathing or dressing, and tell the treating clinician or nurse if you see:

  • A patch that stays red, purple, maroon or darker than nearby skin after the pressure is off
  • Skin that feels warmer, cooler, firmer or softer than the skin around it
  • A blister, a shiny area or a shallow break
  • A spot the person says is sore, burning or itchy

Call 911 if the person has trouble breathing, chest pain, or is suddenly very hard to wake.

How primary care fits in

A new pressure injury is often a sign that a person’s overall health has changed. Perhaps they have become weaker, are sleeping most of the day, or a long illness such as dementia or cancer has advanced. Caring for the wound without asking why it appeared now misses part of the picture.

That is the reason Gateway arranges wound care and primary care side by side. The primary care clinician can reassess the person’s conditions, talk with the family about goals and bring in palliative or hospice care if that fits. The wound clinician can then match the wound plan to those goals, whether that means working toward closure or keeping the person comfortable.

Primary care at home in the Central West End →

How to get started in the Central West End

To arrange pressure injury care in the Central West End, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.

Calling about someone in the Central West End? Have the building name and unit number, how visitors get in, and whether there is a place to park or a loading zone out front. Share a phone number that will be answered on the day of the visit. Street parking and event traffic near the park can slow arrivals, so a visit window is more realistic than an exact time. Gateway also arranges care in nearby University City, Clayton, Downtown St. Louis and the north and south sides of the city.

Related care in the Central West End

Read the full guide to pressure injuries, or see everything Gateway arranges on the mobile wound care in the Central West End page.

Common questions

Does Gateway work with nursing homes and assisted living communities in the Central West End?

Yes. Gateway arranges for partner clinicians to see residents with pressure injuries in skilled nursing, assisted living, memory care and rehabilitation settings, either one resident at a time or through regular wound rounds. Facility staff can refer a resident, and families can ask the facility to contact us. Availability for a specific building is confirmed when the request comes in.

Should a bed sore be left uncovered so it can dry out?

In general, no. Clinicians usually keep pressure injuries covered with a dressing chosen to hold the right amount of moisture, protect the wound from stool and urine, and cushion it from rubbing. A wound left open to dry tends to form a hard crust that slows new tissue. Follow the treating clinician’s dressing orders and ask before changing anything.

What should we have ready before the first wound care visit?

Have a current medication list, any hospital or rehab discharge papers, the insurance cards and the dressings you are using now. Write down when the sore was first noticed and how it has changed. Jot down your questions too, including who to call between visits. If several people share caregiving, try to have the main helper present to hear the plan.

Is Gateway part of Barnes-Jewish Hospital or the other hospitals near the Central West End?

No. Gateway Wound Care is an independent company and is not affiliated with Barnes-Jewish Hospital, SSM Health Saint Louis University Hospital or SSM Health St. Mary’s Hospital. Patients in the Central West End are commonly treated at those hospitals, and their staff can refer to us as they would to any outside service. Clinical decisions during a visit are made by the treating clinician Gateway connects you with.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.