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markmarcus Asked August 2016

How does a doctor decide what device should be used in place for a pressure ulcer?

Is that after a proper skin evaluation. Does the doctor uses any risk assessment tools like braden or waterlow scale to asses the risk before prescribing a product to use in place ? Or is it after a pressure ulcer is formed at least an stage 1 ulcer. Just because of my curiosity, 

markmarcus Sep 2016
hannahhonee73 Does that means we can ask for a device which has the best reviews on the internet though it's not cleared from FDA and still get it reimbursed ?

crickett33 Sep 2016
Please do a browser search for "bed sore prevention" or "bed sore treatment". These sores [on the bum, elbows, feet, etc] are so VERY difficult to heal. And they are so very painful for the patient - especially if they are bed-ridden. Some of the meds do burn, because the skin is very raw. Mom had to have an ointment on her heels and "air boots" - overstuffed cotton booties intended to keep the heels off of the mattress. She did have the alternating air bed [provided by Medicare through Hospice]. i did the 3/4 angle using pool noodles with a travel/neck pillow atop the styrofoam pool noodle to keep her body slightly elevated. i alternated left/right sides about every two hours. The doctor/nurse will not hesitate to write or get you the medicine you need to have on hand or use every time you change the diaper - or more often. Please do what you can to prevent the sores - they appear overnight. Sometimes the points of the 'egg-crate' style of foam mattresses actually hurt. i'd suggest a down-filled [or down alternative] comforter [wrapped in waterproof mattress cover] to sleep on top of. If you get a full sized comforter - just fold it in half for a twin-sized hospital-type bed. You will need the water-proof mattress cover please. This gives them 2-4" of softness to help guard the pressure sores. FYI the comforters are washable - even though they may say 'spot clean only' - i dry them in the dryer too: just toss in a few tennis balls and it helps them fluff up rather than clump up. God bless ~

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Snodin2001 Aug 2016
I would ask your doctor to get a home health nurse or therapist to come to the home to fully assess the situation. Does the person sit all day, in bed all day? If they can, getting up at least once an hour during waking hours is the best prevention. If the person is immobile. then there individual situation needs to be addressed more carefully. Hope this helps.

Llamalover47 Aug 2016
8/28/16-markmarcus: I believe that the doctor will write out a script so that it will be covered by Medicare because of its absolute necessity.

hannahhonee73 Aug 2016
No, hospice has different rules than regular Medicare has, for example, hospice can get oxygen asap if they see a need but other people need to be at a certain % breathing level before Medicare pays. I guess since it's end of life care things aren't questioned as much? I'm not sure.

claradees Aug 2016
also keep the diapers fresh

claradees Aug 2016
I fire my CNA'S when my dad gets pressure or bedsores. they can be prevented if they are being cared for properly! when you first see redness or breakdown of the skin treat with zinc oxide, daily baths, lotion from head to toe, and turning every couple of hours if bedridden, my pops we get out of bed everyday, exercise and never leave in the same position for more than a couple of hours at a time. its a lot of work but it keeps them healthy. and bedsore free.

lifeexperiences Aug 2016
McKesson makes hydrocolloid dressing pads or hydrocellular foam dressing pads that i use even for preventative measures on areas where my mother carries the most weight...side of hips back where the skin is very thin and bone is protruding....but must turn person every 2 or 3 hours .... when possible. i don't overnight but i have my mother propped on a 3/4 angle propped with pillows

Grandma1954 Aug 2016
hannahhonee73...and that sure does not make sense does it since Hospice bills Medicare you would think the same conditions would apply! You would think PREVENTION of a pressure ulcer would be so much better than trying to heal a pressure ulcer.
And when the Nurse orders a piece of equipment it is delivered the same day!

hannahhonee73 Aug 2016
I agree but hospice is different than Medicare as far as mattresses they will cover. The dr wrote a script for an air mattress and the supply company said it was only covered if you have a stage 3. She could have an egg crate and a few other choices but not an air. Now she's on hospice and they brought one in the first 12 hours and she had no bedsores. Hospice gets things done a lot easier and faster.

Grandma1954 Aug 2016
My husband is on Hospice and the Nurse that comes to the house has always ordered the bed or mattress that was needed.
We did go from one type of mattress a memory foam alternating pressure mattress to a mattress that has just air chambers and the firmness and the way the air flows can be changed and it can be set so the bed is either always full of air or it alternates. I am sure if there was a question she would contact the doctor who would then approve a different type of mattress.
If you doctor knows what is going on and you call and say that there is evidence of pink at pressure points an evaluation would probably not be necessary and a mattress would be approved.
Pink spots at pressure points is considered a Stage 1 pressure ulcer. You do not want to wait until you get a fluid filled pressure spot before action is taken.

hannahhonee73 Aug 2016
In my experience, the dr just writes a prescription for what you ask or what he or a nurse thinks you need. I've never seen them do a formal inspection but some things like certain mattresses require a stage 3 sore before insurance pays iirc

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