What to know about pressure injuries

A pressure injury is an area of damaged skin, and often damaged tissue underneath, that forms where the body rests against a surface for too long. Bed sore, pressure sore, pressure ulcer and decubitus ulcer all mean the same thing. These wounds nearly always sit over a bone that lies close to the skin, such as the tailbone, the hip, the heel, the ankle or the back of the head.

A pressure injury is not always an open sore. It can begin as a patch of unbroken skin that looks or feels different, and it can also be a deep crater. Clinicians describe that range with a staging system based on how many layers of tissue are involved. Staging gives everyone caring for the person a shared language for the wound.

What an assessment covers

A pressure injury care plan depends on the whole person, so the treating clinician reviews more than the skin. Expect questions about how much the person can move without help, whether they can feel and report discomfort, how often skin is exposed to moisture, and how well they have been eating and drinking.

The clinician also asks what the person and family want from care. For one person the aim is to close the wound. For another, who is very frail, the aim may be to keep the wound stable, clean and comfortable. Being honest about what caregivers can manage each day helps the clinician write a plan that will be followed.

Arranging this care in Chesterfield and West County

Across Chesterfield and West County, the main family caregiver often works a full day and has a commute on top of it. That can leave a person with a pressure injury in one position for many hours. Tell the treating clinician exactly when help is and is not in the house. The plan can then lean more on the support surface, on paid caregivers or home health, and on positions the person can manage alone, instead of a turning schedule no one is home to follow.

West County spreads out from Chesterfield along Interstate 64 and Olive Boulevard, from the bluffs above the Missouri River to the wooded subdivisions farther south. The area is suburban and car-dependent, with offices and shopping in Chesterfield Valley and neighborhoods of large lots and cul-de-sacs on the higher ground. Gateway’s administrative office is here in Chesterfield, though no patients are seen at it. Care happens where people live. For residents of Chesterfield and West County who cannot easily ride to a clinic, that means a clinician at the front door or at the facility bedside.

Care 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

In a skilled nursing facility, pressure injury care is a shared job. Facility nurses do the daily dressing changes and repositioning, the attending physician oversees the resident’s overall care, and a partner wound clinician can see the resident on site, often during scheduled wound rounds.

After each visit, measurements, staging and updated orders go to the nursing team so the chart and care plan match what the clinician found. Gateway coordinates the rounding schedule, the list of residents to be seen and the supply follow-up. Staff can also call Gateway between rounds when a resident’s wound changes.

Changes to report

Some of the most useful reports are not about the wound at all. They are about changes that put more pressure or moisture on the skin. Let the treating clinician know when:

  • A new area of discolored skin appears somewhere else on the body
  • The person can no longer shift, turn or tolerate a position they used before
  • Incontinence starts or gets worse, or dressings keep getting soiled
  • An air mattress, cushion or heel protector stops working or is not being used
  • Eating or drinking drops off, or weight is falling

These are not emergencies. Call 911 for chest pain, trouble breathing, heavy bleeding or sudden unresponsiveness.

How primary care fits in

Several everyday medical issues affect how much pressure the skin takes. Medications that cause drowsiness can reduce the small movements a person makes while sitting or sleeping. Untreated pain makes people hold still and resist turning. Diarrhea, urinary infections and constipation with leakage keep skin wet. Stiff, contracted joints limit the positions a person can use.

A primary care clinician can review the medication list, pain control, bowel and bladder problems and whether therapy would help with mobility. Do not stop or change a medication on your own. Bring the concern to the clinician, and ask Gateway to share it with the wound care team as well.

Primary care at home in Chesterfield and West County →

Getting care arranged in Chesterfield and West County

Setting up pressure injury care for someone in Chesterfield and West County usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

When you call, it helps to know the subdivision or community name as well as the street address, since some neighborhoods are gated and many streets end in cul-de-sacs. Tell us about gate codes, long driveways and which entrance a facility prefers for visitors. Have the patient’s doctor and pharmacy names handy. Gateway also arranges care in Ballwin, Wildwood, Creve Coeur, Maryland Heights, Ellisville and Des Peres, and visits in Chesterfield and West County are planned with those neighboring areas in mind. Availability is confirmed by location and setting.

  • County: St. Louis County, Missouri
  • ZIP codes: 63017, 63005
  • Nearby hospitals: St. Luke's Hospital in Chesterfield; Mercy Hospital St. Louis in Creve Coeur; Missouri Baptist Medical Center in Town and Country; Barnes-Jewish West County Hospital in Creve Coeur (not affiliated with Gateway)
  • Nearby communities: Chesterfield, Ballwin, Wildwood, Ellisville, Des Peres, Creve Coeur
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Chesterfield and West County

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

Common questions

Will insurance pay for pressure injury care or a special mattress in Chesterfield and West County?

It depends on the plan, the treating provider and the care that is needed. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans, and we will help you find out what applies before a visit. Equipment such as a support surface usually requires a clinician’s order and supporting documentation, and each plan sets its own rules.

What do the stages of a pressure injury mean?

Stages describe depth. Stage 1 is unbroken skin with a color change that does not fade. Stage 2 is a shallow open area or blister. Stage 3 extends into the fat layer under the skin. Stage 4 reaches muscle, tendon or bone. A wound is called unstageable when its base is hidden, and a deep tissue injury is a dark purple or maroon area where the damage lies below the surface.

Does Gateway work with nursing homes and assisted living communities in Chesterfield and West County?

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.

Can care continue if my mother moves from her house in Chesterfield and West County into assisted living?

You can ask for the same arrangement to continue. Let us know the move date and the name of the community as early as you can. Gateway updates the address, contacts the new facility’s nursing staff and sends records ahead. We check availability in the new setting, and the treating clinician adjusts the plan of care to fit the support the facility provides.

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.