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 the treating clinician looks at
Where a pressure injury sits says a lot about what caused it, and the treating clinician reads the location as a clue:
- Tailbone or buttocks: long hours sitting, or lying with the head of the bed raised
- Heels: lying on the back with the feet resting on the mattress
- Hip or outer ankle: time spent on one side
- Ears, nose or cheeks: pressure from tubing or a mask
- Back of the head or shoulder blades: lying flat for long stretches
The clinician then looks at the bed, chair or device involved and asks about the daily routine. A care plan that leaves the source of pressure unchanged is unlikely to succeed, whatever dressing is chosen.
Arranging this care in Franklin County
Distance changes pressure injury care in Franklin County. A long drive to a wound clinic is hard on someone who should not be sitting on the wound, and it may call for special transport. Care brought to the home avoids that. Because visits to outlying areas are planned ahead, Gateway follows up on the treating clinician’s supply orders with the next visit date in mind, to help keep enough dressings in the house until then.
Franklin County lies west of St. Louis County, where the suburbs thin out into river towns, farms and wooded hills. Interstate 44 runs through Pacific, St. Clair and Sullivan. Washington sits on the Missouri River to the north, and Union, the county seat, is in between. Distances are measured differently here. A trip to a specialist can take most of a morning, and winter weather or high water can close a road. For residents who need frequent wound care or regular medical follow-up, having a clinician come to the home or facility can be the most workable arrangement.
When care happens at home
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.
In a facility
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.
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
Tissue under pressure survives on blood flow, so anything that reduces circulation or the oxygen carried in the blood makes a pressure injury more likely and harder to close. Diabetes, peripheral artery disease, heart failure, chronic lung disease and anemia are common examples. Heels are especially sensitive to poor circulation in the legs.
These conditions are managed in primary care. When the wound clinician and the primary care clinician can see each other’s notes, a wound that has stalled can prompt a fresh look at blood sugar, circulation or blood counts. Gateway arranges both kinds of visits and helps keep records moving between them.
Arranging pressure injury care in Franklin County
Before anything is scheduled, Gateway checks two things for every request for pressure injury care in Franklin County: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.
Be specific about location when you call. Franklin County is large, and a Union or St. Clair mailing address can be many miles from town. Give the ZIP code (63090, 63084, 63069, 63077 or 63080 for the main towns), the road name, and landmarks near your turn. Tell us the days someone is home. Visits this far west are planned by area, often together with nearby Eureka, Wildwood or northern Jefferson County, so we may offer particular days. Availability is always confirmed by location and care setting.
- County: Franklin County, Missouri
- ZIP codes: 63090, 63084, 63069, 63077, 63080
- Nearby hospitals: Mercy Hospital Washington (not affiliated with Gateway)
- Nearby communities: Washington, Missouri, Eureka, Wildwood, Jefferson County
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
More wound care in Franklin County
Read the full guide to pressure injuries, or see everything Gateway arranges on the mobile wound care in Franklin County page.
- Diabetic foot ulcers
- Venous leg ulcers
- Arterial and mixed wounds
- Non-healing wounds
- Post-surgical wounds
- Reopened (dehisced) surgical wounds
- Surgical site infections
- Skin tears and traumatic wounds
- Wounds with lymphedema
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Pressure injury and bed sore care in Washington
- Pressure injury and bed sore care in Wildwood
- Pressure injury and bed sore care in Jefferson County
Common questions
Does Gateway work with nursing homes and assisted living communities in Franklin 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.
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 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.
Are home visits in Franklin County scheduled differently from visits closer to St. Louis?
Somewhat. Because of the distances, visits in Franklin County are generally planned by area so a clinician can see several patients on one trip. That can mean fewer choices of day than in the city. Weather and road conditions matter more as well. We explain the options when you call, and we will not promise a time we cannot confirm.
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.