About 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 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 Washington

Around Washington, the nearest equipment supplier may be a long way off, so a specialty mattress, cushion or hospital bed takes planning. Ask at the first visit what to do if a powered air mattress loses power or goes flat, and keep the supplier’s number where every caregiver can find it. Gateway follows up on equipment orders and delivery dates, and confirms ahead of time when a partner clinician can visit that part of the region.

Washington sits on the south bank of the Missouri River in Franklin County, well west of the St. Louis suburbs. It is the largest city in the county and the place surrounding farm communities come to for shopping, work and medical care. Highway 100 leads east toward St. Louis County and Highway 47 crosses the river to the north. Outside the city limits the roads turn rural fast. For a person with a wound who lives miles out, or who no longer drives, care arranged at home or in a local facility can replace a long round trip.

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.

For residents of nursing and senior living communities

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.

Changes to report

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.

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.

Primary care at home in Washington →

How to get started in Washington

To arrange pressure injury care in Washington, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.

Calling about someone in Washington? Have the full address ready, including a county road or highway number if the home is outside the city, plus landmarks that help a visitor find the driveway. We will also ask for a callback number, the doctor’s name and any recent hospital paperwork. Gateway coordinates care elsewhere in Franklin County and in Eureka and Wildwood to the east. Because of the distances involved, knowing the exact address early helps us confirm what can be arranged.

  • County: Franklin County, Missouri
  • ZIP codes: 63090
  • Nearby hospitals: Mercy Hospital Washington (not affiliated with Gateway)
  • Nearby communities: Franklin County, Eureka, Wildwood
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Washington

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

Common questions

Will insurance pay for pressure injury care or a special mattress in Washington?

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.

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.

Can I call before a planned surgery in Washington to line up wound follow-up?

Yes, and it is a sensible step. Tell us the surgery date, the hospital, the surgeon’s name and where you will recover. Gateway can gather information ahead of time and coordinate with the discharge planner once you are admitted. The surgeon’s instructions come first, and the treating clinician decides what wound follow-up at home in Washington should involve.

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.