Understanding pressure injuries

Pressure injuries change slowly, and the early changes can be confusing. Damage that started deep may take days to show on the surface, so a wound can look worse at first even while care is going well. Dead tissue has to clear before new tissue can grow.

Healing happens from the base upward as the wound fills in and the edges draw together. The treating clinician tracks this with measurements at each visit, because week-to-week change is hard to judge by eye. Once closed, scar tissue forms over the area, and it is weaker than the original skin, so the same spot can break down again. Protecting that area continues long after the wound has closed.

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 St. Peters

From St. Peters, a specialist appointment can mean a long car ride each way. For someone with a pressure injury on the tailbone or hip, that ride is extra time sitting on the wound, followed by a waiting room chair. Having a partner clinician come to the home or senior living community takes that sitting out of the picture. Gateway confirms visit availability for the address first, then schedules and follows up on dressing and equipment orders.

Interstate 70 carries most of the traffic through St. Peters, a St. Charles County city set between St. Charles to the east and O’Fallon to the west. Mid Rivers Mall Drive is the main north-south route, lined with shopping centers, and subdivisions fill in the blocks behind it. It is a car-dependent place. When a wound, weakness or a recent surgery makes getting in and out of a car hard, even a short drive to an appointment becomes a project. Care that comes to the home or facility takes the car out of the picture.

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.

Care in skilled nursing and assisted living

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.

Signs to tell the clinician about

An infected pressure injury can make the whole body sick, and in frail older adults the first sign is often a change in behavior, not a change in the wound. Contact the treating clinician promptly about:

  • Fever or shaking chills
  • Redness, warmth or swelling spreading out from the wound
  • Pus or cloudy drainage
  • Pain that is new or clearly worse
  • New confusion, unusual sleepiness or refusing food and drink

Call 911 if the person is very confused or unresponsive, is breathing fast or with difficulty, or looks suddenly and seriously ill.

Why primary care matters here

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 St. Peters →

How to get started in St. Peters

If you have been managing a wound mostly on your own and are looking for pressure injury care in St. Peters, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

Before calling Gateway at 314-325-0126, gather a few things: the St. Peters street address, a good callback number, the name of the patient’s doctor, and discharge papers if there was a recent hospital or rehab stay. An insurance card is useful for coverage questions. We also coordinate care in St. Charles, O’Fallon, Cottleville, Weldon Spring and elsewhere in St. Charles County. Visit availability is confirmed by location and care setting, so tell us whether the patient is at home or in a facility.

  • County: St. Charles County, Missouri
  • ZIP codes: 63376
  • Nearby hospitals: Barnes-Jewish St. Peters Hospital; SSM Health St. Joseph Hospital in St. Charles; Progress West Hospital in O'Fallon (not affiliated with Gateway)
  • Nearby communities: St. Charles, O'Fallon, Missouri, Cottleville, Weldon Spring, St. Charles County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in St. Peters

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

Common questions

Will insurance pay for pressure injury care or a special mattress in St. Peters?

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.

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.

Is all of the 63376 ZIP code in St. Peters part of Gateway’s area?

Gateway coordinates care across St. Peters and the surrounding parts of St. Charles County, which includes the 63376 ZIP code. Because availability is confirmed by location and care setting, the surest way to know is to call 314-325-0126 with the street address. We will tell you plainly what can be arranged there.

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.