Archive for the ‘Litigation Wound Care’ Category

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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Can You Use Job Burnout as a Legal Defense?

Friday, November 10th, 2017

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

Wound care is a stressful profession, and sometimes your empathy bucket becomes empty, but job burnout is not a proper professional or legal defense.

Can You Use Job Burnout as a Legal Defense?

 

A group of my professional friends were having lunch together and catching up when one friend disclosed that she was taking a month off of work. We all looked at her agape and at the same time exclaimed “a month?” We had a dozen questions for her. Was she ill? How did she arrange this? What did her supervisor say? Would she still have her job at the end of the month? And most importantly, why was she taking a month off?

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Malpractice or Obesity: Can a 276-Pound Patient Heal a Pressure Injury?

Friday, September 8th, 2017

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Obesity presents challenges to wound healing, but with knowledge and appropriate care interventions, we can provide optimal conditions to support the best possible outcome for every patient, no matter what size.

Malpractice or Obesity?

 

The US obesity epidemic reached a new all-time high in 2016, according to newly released Centers for Disease Control and Prevention data.1 Every single state has an obesity rate greater than 20%, and in five states it’s even greater than 35%. Topping the chart is West Virginia, at 37.7%.

Many of these people end up in the healthcare system because of obesity-related diseases and sometimes develop a wound, such as a pressure injury. As we know, wounds that do not heal after 12 weeks are termed chronic, and lawsuits because of chronic wounds and their consequences are rampant

The Obese Plaintiff

The discovery process surely will reveal whether a patient was overweight or obese because nutritional status and body weight are factors in the healing process. The tricky part is deciding how much, if any, of the chronicity of the wound was because of obesity.

In a recent case, the patient was 5′3″ and weighed 276 pounds. Can a person of this size heal? The defendants claimed they did everything according to the standard of care, but despite excellent care, the patient did not heal. They recounted some difficulty repositioning the patient because of her size and problems with moisture management in her skin folds. The plaintiff thought those were excuses and that there was size bias in the care given to the patient. So what are the facts when dealing with a larger patient with a wound?

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Three Common Reasons You Might Get Sued

Friday, August 11th, 2017

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Patients often sue for reasons that have nothing to do with the quality of the medical care rendered, but rather for the human care that is perceived as lacking.

Three Common Reasons You Might Get Sued

 

The last few weeks were very difficult for my family and friends in the medical sense. I had one family member in an intensive care unit on the West Coast, one friend’s father in a rehab facility on the East Coast, and one friend’s son having problems in the outpatient setting in the Midwest. These patients are male and female, young and old, and have very different medical histories, but they all have one thing in common. They all want to sue about their medical care or lack thereof. These cases illustrate three common reasons you might get sued. Let’s take a closer look at what has gone wrong for each patient.

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Truth or Consequences: Admitting Your Wound Care Program Needs Improvement

Friday, June 9th, 2017

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Some healthcare providers are working in underperforming facilities, and they need to discuss how to improve outcomes before it becomes a matter of legal record.

Truth or Consequences: Admitting Your Wound Care Program Needs Improvement

 

“I didn’t have any special training in wounds. No one else wanted to do it, so I said okay.”

“The weekends were really bad. We only had a few people working weekends.”

“I know some of the patients didn’t get turned all day.”

“We always were running out of supplies, so I improvised.”

All of these confessions, or truths, are from real life depositions of nurses who were working in facilities that patients were suing because they developed wounds. These nurses were not trying to hurt their facility in any way or stymie the defense team, but were simply telling the truth in their opinion.

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Nine Wound Care Documentation Pitfalls to Avoid

Friday, May 12th, 2017

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Lawsuits often are settled out of court because the medical record documentation is not defensible. Incomplete, illogical, and inconsistent records are far too common, so it is important to avoid the common pitfalls.

9 Wound Care Documentation Pitfalls to Avoid

 

After reviewing hundreds of medical charts involved in litigation, I noticed many of the same problems occurring in the wound care documentation over and over again. From New York to Florida to California, it is remarkable how the same inconsistencies, errors, and oversights tend to stymie the defense of a case. The goal of every healthcare practitioner is to have complete, accurate, and timely documentation of the medical care given to each and every patient. Here are nine wound care documentation pitfalls to avoid.

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