About pressure injuries

Skin and muscle need a steady supply of blood. When body weight presses tissue between a bone and a mattress or seat, the small vessels in that tissue are squeezed shut. If the pressure is not relieved, the cells run short of oxygen and begin to die.

Pressure is rarely the only force at work. Shear happens when the skin stays put while the skeleton slides, as it does when a person slumps down in a raised bed. Friction rubs the surface raw. Dampness from urine, stool or sweat weakens the outer layer so it breaks more easily. A healthy person shifts without thinking, even in sleep. A pressure injury forms when illness, weakness or numbness takes that automatic movement away.

What an assessment covers

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 North St. Louis

When someone in North St. Louis comes home from a large medical center with a pressure injury, the hard part often begins at the front steps. From an upper-floor apartment, each trip to an outpatient wound clinic means stairs, a transfer and a long sit in a waiting room, all of which load the wound. Gateway can arrange for a partner clinician to see the person at home and helps gather the hospital’s wound notes and discharge orders beforehand.

North St. Louis is the common name for the city neighborhoods north of Delmar Boulevard, running up through The Ville, Fairground, Penrose, Walnut Park and Baden to the city limits. Natural Bridge Avenue, North Grand Boulevard, Kingshighway and Interstate 70 are the main routes. These are old neighborhoods with deep family roots, and many elders have lived on the same block most of their lives. The large hospitals are in the central corridor or out in the county, so a wound check or a doctor’s visit often means crossing town. Care at home shortens that distance.

Care 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.

Signs to tell the clinician about

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.

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 North St. Louis →

Arranging pressure injury care in North St. Louis

Clinicians and facility staff referring a patient for pressure injury care in North St. Louis 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.

Have these ready when you call 314-325-0126: the patient’s name, street address and ZIP code, a main phone number and a backup, and the name of any doctor or health center they use. If the patient stays with different relatives during the week, say so. Gateway also arranges care elsewhere in the City of St. Louis, including Downtown and the Central West End, and across the line in Ferguson and North County. Visit availability is confirmed for each address, and a reachable phone number keeps scheduling on track.

  • County: City of St. Louis, Missouri (an independent city)
  • ZIP codes: 63106, 63107, 63113, 63115, 63120, 63147
  • Nearby hospitals: Barnes-Jewish Hospital; SSM Health Saint Louis University Hospital; Christian Hospital in North County (not affiliated with Gateway)
  • Nearby communities: St. Louis City, Downtown St. Louis, Central West End, Ferguson, North County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in North St. Louis

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

Common questions

Does Gateway work with nursing homes and assisted living communities in North St. Louis?

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 sitting in a wheelchair or recliner cause a pressure injury?

Yes. Sitting puts much of the body’s weight on a small area under the sitting bones and tailbone, so pressure injuries can form in a chair as readily as in a bed. People who sit most of the day need a suitable cushion and regular changes of position. The treating clinician can advise on the cushion and on how long the person should sit at a stretch.

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.

Is Gateway connected to Barnes-Jewish Hospital or other hospitals near North St. Louis?

No. Gateway is a separate company that coordinates care with partner clinicians. It is not affiliated with Barnes-Jewish Hospital, SSM Health Saint Louis University Hospital or Christian Hospital. Patients in North St. Louis who received care at those hospitals can still ask us about follow-up at home, and with permission we request records so the treating clinician knows what was done during the hospital stay.

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.