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How to Avoid 30 day hospital readmission for a discharged elderly patient.

Updated: Jan 19

Nurse discharging patient from hospital and providing Telecare My SOS Family Emergency alert service
Hospital Discharging

Hospital Patient Readmission rates are at record numbers as they are readmitted to hospital...

...within 30 days of being discharged because of preventable conditions with the biggest cause being Pressure sores (a.k.a. Pressure ulcers, Bedsores and Decubitus ulcers).

A large majority of these conditions aren’t picked-up / diagnosed when patients are first admitted to hospital and therefore could be preventable.

What are Pressure sores/ulcers?

Hospital Patient Readmission rates because of Decubitus ulcers is high worldwide, in the UK they are called Pressure sores, in the USA they are better known as Pressure ulcers and other names include Bedsores and Decubitus ulcers.

Pressure sores/ulcers is a type of injury that breaks down the skin and underlying tissue because an area of skin is placed under constant pressure for some time and the area doesn’t get enough nutrition and oxygen supplied to it.

What causes Pressure sores/ulcers?

Pressure ulcers develop either when over a short period of time to much pressure is applied, or over a long period of time less pressure is applied and reduces the blood flow which supplies nourishment to skin.

Whilst it’s more common in older adults, some common causes are below:

· Continuous rubbing, friction or pressure against the skin.

· Shearing

· Immobility e.g., staying in bed or a wheelchair for prolonged period.

· Inability to move certain part of the body because of an injury.

· Blood flow affecting diseases like diabetes or vascular diseases.

· Poor diet with not enough nutrition

· People with fragile skin.

· Poor mental state because of depression or Alzheimer disease.

Pressure ulcers/sores are more common with those with health conditions both mental or physical that results in a sedentary lifestyle, in particular if confined to a chair or bed for some time.

This is also accelerated with blood supply health conditions, like type-2 diabetes and nearly 70% of people with pressure sores are those aged 60 to 80 years of age so age is also an important factor.

Shearing is like bending a hose pipe when flow of water is cut-off , in the same way shearing can stop blood flow and ulcers will happen more quickly , parts of the body more susceptible to shearing are elbows, heels and shoulder blades.

Loss of sensation of pain normally signals people to change position which is lost.

What are the symptoms of Pressure sores/ulcers?

There are 4 stages of from 1 being the mildest to 4 being the most severe and two types that don’t fit into one of the four stages. Two Uncategorized symptoms are: a) Sores covered in dead skin that’s tan, brown or yellow. Dead skin mean it’s difficult to see how deep the sore is.

b) Pressure ulcers can develop within the tissue deep under the skin, called a deep tissue injury and may be maroon or dark purple or a blood-filled blister under the skin.

This is quite a progressive pressure sore.

The 4 main grades and stages of pressure ulcers /sores are:

  1. A reddish, painful area that doesn’t turn white when pressed , the skin could be softer, firmer, cooler or hotter than the surrounding skin and could be an indication a pressure sore / ulcer is beginning to form.

  2. There is an open sore on the skin or a blister and around the sore the skin is irritated or red.

  3. There’s a crater or ulcer on the skin like a sunken hole, maybe body fat can be seen in the ulcer and thee skin is damaged.

  4. The pressure ulcer is really deep and damage to muscles, bone, tendons or joints.

Where are Pressure sores/ulcers formed?

Bony areas because there’s less tissue like:

· Back of the head,

· Back

· Shoulders

· Ankles & heels

· Buttocks

· Elbows

· Hips

What relief and remedies help with Pressure ulcers/sores?

  • Cleaning of the wound and meticulous skin care is the most essential part of the recovery and treatment. Removal of surface contamination and dead tissue is essential.

  • Change dressings and clean sores regularly.

  • Avoid using cleaners that will damage the skin like hydrogen peroxide or iodine cleansers.

  • Relief the pressure.

  • Use fam cushions, booties mattress pads, special pillows, foam or water filled.

  • Change position every 15 minutes if in a wheelchair and when in bed every 2 hours.

  • Washing gently with mild soap and water works for stage/grade I Pressure sores as well as using moisture barrier to protect the area from bodily fluids.

  • Saline / Saltwater rinsing and removing dead skin works for stage/grade II Pressure ulcers.

  • Protect against infection with special dressing, keeping the sore moist to aid healing

  • Pressure sores/ulcers that are stage/pase III and IV need special treatment, consult medically trained support.

  • Eat good nutritional food and lose excess weight.

  • Get plenty of sleep

  • Powder sheets so the skin doesn’t rub in bed.

When to seek medical help for Pressure sores / ulcers ?

  • Infected sores / ulcers.

  • Fever

  • Tenderness or Redness around the sore / ulcer.

  • Smelly sores / ulcers.

  • Pus excreting from sores / ulcers

Patient Wellbeing Closely Linked to 30-Day Readmission Rates

Within United Sates a Gallup study found that there is a close link between the welling being of patients and 30-day admission rates after being discharged from the hospital.

Defining wellbeing fell into these key areas :

· Career wellbeing: You like what you do every day.

· Social wellbeing: You have meaningful friendships in your life.

· Financial wellbeing: You manage your money well.

· Physical wellbeing: You have energy to get things done.

· Community wellbeing: You like where you live.

Whilst My SOS Family can’t help with Career, Financial or Physical wellbeing, it can help with Social wellbeing and community wellbeing , in terms of leaving hospital and being provided with the My SOS Family emergency alert service for an Alexa device, a landline or cordless phone or the My SOS Family Emergency alert App for an iPhone or Android smartphone in itself is helpful but more importantly ;

Giving them My SOS Family Alert service tells them that there are people who care and love them and want to help them, this makes them feel less isolated, know they have a community that will help them and meaningful friendships.

Coupled with calling and checking in on them regularly and every day and also visiting them provides them with a reason to get up, get ready and be positive.

My SOS Family provides everyone with a free 30 day no-obligation and no credit card needed fee-trial. We know that there will be some patients and their family and friends who may just want to use the service for first 30 days after being discharged from hospital to help them on their path to recovery.

We are glad we played a small positive part in their lives.


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