Archive for the ‘Litigation Wound Care’ Category

Learn how written discharge instructions can protect your practice

Tuesday, July 16th, 2019

discharge instructions

Accurate, complete and defensive documentation is essential in all areas of practice, and wound care nursing is no exception.

wound care

By Nancy J. Brent, MS, JD, RN

One component of documentation that is of utmost importance is written discharge instructions. In the following case, this was one of the central issues the federal court had to evaluate — Shelton v. United States, 804 F. Supp. 1147.

The patient sought treatment at a VA hospital after he was bitten on the tip of the middle finger of his right hand during an altercation with a female after they left a bar.

The wound was painful and bleeding.  He called 911, stating he had been shot. He would not allow the paramedics to examine his finger.

The ED admitting nurse noted on the admission form he had suffered “trauma” to his right middle finger. He was then seen by an ED physician, whom he told he was bitten and that he had been shot.

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Should wound care nurse carry out off-label use order?

Monday, June 3rd, 2019

off-label

A reader submitted a question about a physician ordering her to crush two Flagyl tablets and sprinkle them onto a patient wound.

wound care

By Nancy J. Brent, MS, JD, RN

The nurse knew this was not the correct way to administer the medication. However, she is concerned that since the physician ordered this method of administration that she is obligated to follow the order.

Part of this nurse’s conflict is that this method of administration is not generally consistent with current standards or practice.

But in many facilities and home care agencies, the use of Flagyl tablets in this way is a common and customary practice, as we discuss in our blog, “We’ve Always Done It This Way:  Flagyl Crushing & Other Wound Care Bad Habits.”

However customary such a use may be, it can create potential legal liabilities for you.

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Substandard wound care can lead to legal risk for clinicians

Monday, May 20th, 2019

professional negligence

Dedicated wound care professionals pride themselves on providing optimum care for their patients.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

Did you know you also have an ethical and legal obligation to provide the best care possible or you face legal risk?

You could be held liable whether you are an experienced or new wound care clinician, certified or not certified, or work in acute care, long-term care or the ambulatory environment.

Providing substandard wound care not only harms patients, it also can result in a patient or their family taking legal action against you and other clinicians involved in the patient’s care plan, said Nancy Brent, JD, MS, RN, a nurse attorney who represents nurses before the state regulatory agency and has a solo law practice in Wilmette, Ill.

And no one wants to face professional negligence or malpractice allegations.

“The legal fallout from litigation pertaining to patient care can range from being sued for medical malpractice or professional negligence, in addition to the fees related to legal representation and damages owed if you’re held legally responsible,” she said.

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Case illustrates importance of clear wound care delegation

Friday, April 12th, 2019

delegation

In the following case, the issue of delegation of wound care was the focus of the case.

wound care

By Nancy J. Brent, MS, JD, RN

A female patient’s doctor ordered home healthcare services after her hospitalization for renal disorders and congestive heart failure. The patient employed a local home healthcare agency to provide skilled nursing care for the patient’s many health problems.

Six months later, the physician discovered his patient had developed four decubitus ulcers, including one on her right hip, which measured 5-1/2 centimeters in diameter and 7-1/2 centimeters deep.

The physician ordered the nurses to clean the wounds regularly and two months after the orders were being carried out, he delegated to the nurses to begin to pack the right hip wound with Betadine gauze.

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Legal issues clinicians should know when taking wound care pictures

Wednesday, April 3rd, 2019

wound care pictures

Regardless of where a wound care professional practices, following the trajectory of a wound is essential to providing the best care.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

In addition to measuring wounds, part of today’s practice sometimes includes taking wound care pictures. The steps involved when photographing wounds depends on your organization’s written policies and procedures.

Some healthcare organizations provide computer-based applications and devices that wound care staff are required to use when taking wound care pictures. These photos are typically uploaded into each patient’s electronic medical record.

Other employers may not provide these tools, however. When this occurs, wound care clinicians may be tempted to use their personal cell phones to take wound photos to monitor the success of their care or share with other clinicians for advice.

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What do I need to know about professional liability insurance for nurses?

Tuesday, March 19th, 2019

professional liability insurance for nurses

One of our members submitted a question about what type of professional liability insurance for nurses she should purchase, especially since she is now certified in wound care.

wound care

By Nancy J. Brent, MS, JD, RN

Questions about professional liability insurance are constantly raised by nurses in all areas of nursing practice.

Wound care nurses are no exception, and this topic was briefly covered in on our blog titled Wound Consulting Business: How to Get Started.

There is a great deal of important information for you to know as a wound care nurse before selecting a professional liability policy.

Before discussing that information, it is important to emphasize that as a practicing wound care nurse, you need to purchase your own professional liability insurance policy.

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Wound care specialist has legal concerns when asked about clinical issues ‘on the fly’

Wednesday, March 6th, 2019

wound care specialist

A reader who is the wound care specialist at her facility submitted a question about being approached by wound care clinicians regarding patient care issues when she is in the hallway, at lunch or is leaving the facility for the day.

wound care

By Nancy J. Brent, MS, JD, RN

She wonders how to handle these situations since she knows her “duty” as a wound care specialist starts when clinicians seek a consultation.

She is right to be concerned about evaluating a patient’s wound care at times when she cannot focus on the case.

In a 2013 study analyzing five years of medical malpractice cases, 7,149 out of 23,000 medical claims and lawsuits involved communication failures. Inpatient settings accounted for 44% of the cases, and 9% of the cases involved nurses/nursing. (more…)

The Head to Toe Search for Wounds

Tuesday, June 12th, 2018

Nancy Collins, PhD, RDN, LD, NWCC, FAND

 

A comprehensive skin assessment should look for more than just wounds because many medical problems have telltale signs that are easy to see if you know what to look for.

comprehensive skin assessment

 

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

 

POA. These three little letters have become very important in wound care because we must document any wounds present on admission (POA). By doing so, we are saying that these wounds began somewhere else—maybe at home, maybe in another care setting, but definitely not while under the present facility’s care. This distinction of origin has great implications both financially and legally.

 

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Nutrition Tips for Wound Patients With Cancer

Friday, May 11th, 2018

Nancy Collins, PhD, RDN, LD, NWCC, FAND

Patients with wounds usually have multiple medical problems, and often the other diagnoses make meeting the nutritional plan difficult, such as when the wound patient also has cancer.

Nutrition Tips for Wound Patients With Cancer

 

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

I often discuss the increased nutritional requirements to fuel wound healing. Patients need extra calories and protein each day, plus an adequate amount of fluids, the right mix of vitamins and minerals, and any adjuvant treatments, such as targeted amino acids. A question that I often am asked is how you accomplish this when the patient has an additional diagnosis that impedes or supersedes the recommended nutritional plan. It is rare that a patient presents with only a single medical problem, and sometimes the other problems pose challenges to the nutritional plan.

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Stinging. Burning. Painful. Wounds Hurt!

Saturday, March 10th, 2018

Nancy Collins, PhD, RDN, LD, NWCC, FAND

The pain of a wound is sometimes difficult to quantify, but if a patient complains of pain, this requires effective and timely pain management.In the midst of the war on narcotics, that might mean looking for alternative pain management techniques and learning new approaches.

Wound Pain

 

Several months ago, I was attacked by the most venomous scorpion in North America, the Arizona bark scorpion. This stealth attack happened while I slept in my own bed at home in our southern Nevada desert home. I woke up with a jolt knowing that something was terribly wrong with me, but not quite sure what was happening. I felt a fiery tingling pain in both my hands and my abdomen, yet at the same time I also had a total loss of feeling in those areas. I remember yelling to my family that I was paralyzed, but they were confused because I was running around and frantically waving my arms obviously not paralyzed at all. We only figured out what had happened when I tried to crawl back into bed and saw the scorpion on my pillow.

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

My scorpion stings were an indescribable sensation and unlike any type of pain I had ever experienced. Even today, I am struggling to find the words to tell you what it felt like. All I knew was that it hurt and was unlike any pain I had previously experienced or could even compare it to. For the record, I did some research afterward—people describe it as feeling quite similar to being electrocuted.  Luckily, I can say that I was never electrocuted, but that is how people describe it.

Just as luckily, I have never had a pressure injury or a diabetic foot ulcer, so I am not really sure what those feel like either. My patients tell me they hurt. Some patients seem like they are in extreme pain, while others seem to have only mild pain. How do we quantify pain, and more importantly, how do we manage it effectively?

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