Understanding 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

The first visit starts with a close look at the wound itself. The treating clinician notes exactly where it is, measures its length, width and depth, and checks whether it extends under the skin edges. The type of tissue in the wound bed matters, as does the amount and color of drainage and the condition of the skin around it.

From these findings the clinician assigns a stage, or records that the wound cannot be staged yet because its base is hidden. The same measurements are repeated at later visits. Comparing them over time is how the clinician judges whether the current orders are working or need to change.

Pressure injury and bed sore care in Creve Coeur

People in Creve Coeur with a pressure injury often move between settings: home, a hospital stay, a few weeks of rehabilitation, then perhaps assisted living or skilled nursing close by. Each move brings a new bed, new caregivers and a risk that the turning plan and wound orders get lost. Gateway arranges wound care in private homes and in senior living and nursing facilities across Creve Coeur, and helps the latest measurements and orders travel with the person.

Creve Coeur sits where Olive Boulevard meets Interstate 270, a West County city that mixes medical offices and corporate campuses with established neighborhoods. Lindbergh Boulevard runs along its eastern side, and New Ballas Road runs north to south through the middle. Because two hospitals and many physician offices are inside the city limits, it is easy to assume care is always within reach. Yet a person with a slow-healing wound, a walker and no driver may find a one-mile trip as hard as a ten-mile one. Bringing care to the home or facility removes that trip.

At home between visits

Most pressure injury care happens in the hours between visits. Someone has to change the dressing as ordered, help the person turn, keep skin clean after incontinence and look over the bony areas for new color changes. Before the clinician leaves, ask who is expected to do each task and what to do if a dressing comes loose early.

A simple written log helps. Note position changes, dressing changes and anything that looks different, and show it at the next visit so the clinician can see what the days are really like. Call Gateway at 314-325-0126 if supplies are running short or a visit needs to be moved.

For residents of nursing and senior living communities

Pressure injuries in memory care come with particular challenges. A resident with advanced dementia may not be able to say that a spot hurts, may resist being turned, may sit in one favorite chair for hours, or may pull at a dressing. Staff who know the resident are usually the first to notice a change in mood, sleep or willingness to sit.

Partner clinicians see residents in the memory care setting, which spares the resident a trip to an unfamiliar clinic. The treating clinician takes behavior into account when writing orders, and Gateway shares the plan with nursing staff and the family member or representative who makes decisions.

Changes to report

Once a pressure injury is being cared for, the treating clinician needs to hear about changes in the wound between visits. Report any of these:

  • The wound looks wider or deeper than it did at the last visit
  • Black, brown, gray or thick yellow tissue appears
  • Drainage increases, soaks through the dressing or changes color
  • A new or stronger odor that remains after the wound is cleaned
  • The edges lift or a pocket seems to open under the skin

Call 911 for bleeding from the wound that will not stop, or if the person collapses or cannot be roused.

Primary care and overall health

The body builds new tissue from what a person eats and drinks, and a pressure injury raises the demand. Someone who has lost weight, eats only a few bites at meals, has trouble swallowing or has poorly fitting dentures may not be taking in enough protein, calories or fluid to keep up.

A primary care clinician can look for the reason appetite has fallen, review weight over time and decide whether a dietitian or a swallowing evaluation would help. Gateway can arrange primary care in the same home or facility where wound visits take place, so the clinician who orders the dressing and the clinician who looks at nutrition are working from the same information.

Primary care at home in Creve Coeur →

How to get started in Creve Coeur

Clinicians and facility staff referring a patient for pressure injury care in Creve Coeur can call 314-325-0126 or fax 314-786-7966. Helpful to include: demographics and insurance, the working diagnosis, recent wound notes and measurements, current orders, the medication list and relevant test results. Please also tell us who should receive the treating clinician’s notes afterward. The online referral form takes contact details only, so clinical records should come by fax, not through the form. Gateway confirms that the referral arrived, checks availability for the patient’s address and lets your office know what has been scheduled.

To arrange care in Creve Coeur, start with the basics: the patient’s full name, the address in 63141, a callback number and the name of the primary care physician. If the person lives in a senior community, add the apartment number and the nurse’s station phone. Because Creve Coeur sits at the junction of Olive Boulevard and Interstate 270, visits can be planned along with Maryland Heights, Ladue, Overland, Des Peres, University City and Chesterfield. Let us know about days that will not work, such as dialysis or therapy days.

  • County: St. Louis County, Missouri
  • ZIP codes: 63141
  • Nearby hospitals: Mercy Hospital St. Louis in Creve Coeur; Barnes-Jewish West County Hospital in Creve Coeur; Missouri Baptist Medical Center in Town and Country (not affiliated with Gateway)
  • Nearby communities: Chesterfield, Maryland Heights, Chesterfield and West County, Ladue, Overland, Des Peres
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Creve Coeur

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

Common questions

Does Gateway work with nursing homes and assisted living communities in Creve Coeur?

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.

What is debridement, and will my family member need it?

Debridement means removing dead tissue from a wound so healthy tissue can grow and infection is less likely. There are several methods, some using dressings or ointments and some done by a clinician with instruments. Not every pressure injury needs it, and in some situations it is avoided. The treating clinician decides whether, when and how, and will explain the reasons.

Does a bed sore mean someone was neglected?

Not necessarily. Many pressure injuries can be prevented with good positioning, skin care and equipment, and it is reasonable to ask how one developed. But they can also occur despite attentive care, especially in people who are very ill, very thin or near the end of life. The useful questions are what the plan is now and who is carrying out each part.

Does Gateway arrange visits to senior living communities along Olive Boulevard in Creve Coeur?

Yes, visits can be requested for residents of independent living, assisted living, memory care and skilled nursing in Creve Coeur. The resident, a family member or the community’s staff can contact us. We coordinate with the nursing or wellness office on a visit time and on who will carry out orders between visits. Each community sets its own rules for outside clinicians, so it helps to ask them too.

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.