Understanding 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.

How the care plan is built

After the assessment, the treating clinician writes orders and explains them to the people who will carry them out. A pressure injury plan usually has several parts:

  • Wound orders: how the wound is cleaned and covered, and how often the dressing is changed
  • Pressure relief: the mattress, cushion or heel protection to use
  • Positioning: which positions to use, which to avoid and how often to change
  • Skin care: keeping the area clean and dry after incontinence
  • Follow-up: when the wound will be checked again

Gateway follows up on the supply and equipment orders and shares the plan with the caregivers, home health nurses or facility staff involved.

Arranging this care in O’Fallon

Some people in O’Fallon have long crossed the river to St. Louis for specialty care. With a pressure injury, that trip means extended sitting in a car and then a clinic chair, which works against the wound. Gateway can check whether a partner clinician is available to visit the home or facility on the Illinois side instead. Coverage and the treating provider are confirmed before the visit, and records from hospitals in either state are gathered for the clinician.

O’Fallon, Illinois is a St. Clair County city on Interstate 64, with Shiloh to the south, Fairview Heights to the west and Lebanon farther east. Scott Air Force Base is nearby, and many households have a tie to it, from active-duty families to retirees who decided to stay. The city has grown outward from its old downtown into wide areas of newer subdivisions. Even with a hospital in town, regular trips for wound care or follow-up visits are tiring for someone who is recovering or frail, and care arranged at home or in a facility spares them that.

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.

Care in skilled nursing and assisted living

Assisted living communities are not staffed like nursing homes, and that shapes pressure injury care. Aides may help with bathing and transfers, but skilled dressing changes are often done by a visiting home health nurse or, where the community’s license allows, by its own nurse.

When Gateway arranges a wound visit in assisted living, we ask early who handles each part: dressing changes, repositioning, incontinence care and equipment. The treating clinician’s orders are shared with the community’s nurse or director, the home health agency if one is involved, and the family. A resident who now needs far more hands-on help may prompt a wider talk about the level of care.

What to report and when to call 911

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.

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 O'Fallon →

Arranging pressure injury care in O’Fallon

Clinicians and facility staff referring a patient for pressure injury care in O’Fallon 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.

Say “O’Fallon, Illinois” and give the ZIP code 62269 when you call, since there is an O’Fallon in Missouri too. Have the street address, a phone number, the discharge date if there was a hospital stay, and the names of the patient’s doctors. Gateway also arranges care in Fairview Heights, Belleville, Collinsville and other parts of St. Clair County. O’Fallon is easy to reach from Interstate 64, but availability still depends on location and care setting, and we confirm it before scheduling.

More wound care in O’Fallon

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

Common questions

Will insurance pay for pressure injury care or a special mattress in O’Fallon?

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.

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.

How quickly can a pressure injury develop?

Faster than most families expect. In a person who is very frail or cannot move, damage can begin within hours of unrelieved pressure, for example during a long wait on a hard stretcher, a lengthy surgery or a day spent in one chair. That is why any new discoloration over a bone after a hospital visit, a procedure or an illness deserves a prompt call to the treating clinician.

Can a military retiree or a service member’s relative living in O’Fallon request care?

Yes. Anyone in O’Fallon can call Gateway to ask about care, with or without a referral. Have the insurance card available. You can ask about Medicare, Medicare Advantage, Medicaid and commercial plans, and whether a particular plan applies depends on the treating provider, the plan and the care needed. If family members are deployed or live elsewhere, tell us who the local contact should be.

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.