Posts Tagged ‘Dr. Nancy Collins’
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.
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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Tags: burnout, Dr. Nancy Collins, Lawsuit, Nancy Collins, psychology, stress
Posted in Legal, Litigation Wound Care | Comments Off on Can You Use Job Burnout as a Legal Defense?
Friday, October 13th, 2017
Nancy Collins, PhD, RDN, LD, NWCC, FAND
Chronic wounds impact 15% of Medicare beneficiaries at an estimated annual cost of $28 billion to $32 billion, making nutrition a seemingly cost-effective purchase.
Nancy Collins, PhD, RDN, LD, NWCC, FAND
Did you ever wonder how much it really costs to treat and heal various wounds? Patients, family members, and healthcare team members often complain to me that $5/day for nutrition therapy is “too expensive.” Cost is relative, because according to the first comprehensive study of Medicare spending on wound care, it appears that an investment in medical nutrition therapy is a wise investment indeed.
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Tags: CMS, Cost of wound care, Dr. Nancy Collins, Medicare, Nancy Collins, Nutrition, wound care spending
Posted in Nutrition, Wound Care, Wound Care Costs | Comments Off on Medicare Spending on Wound Care: The First Comprehensive Study
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.
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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Tags: bariatric wound care, Dr. Nancy Collins, malnutrition and healing, medico-legal, Nutrition, obesity, pressure injuries
Posted in Litigation Wound Care, Nutrition | Comments Off on Malpractice or Obesity: Can a 276-Pound Patient Heal a Pressure Injury?
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.
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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Tags: Dr. Nancy Collins, Lawsuit, medico-legal, Nancy Collins
Posted in Legal, Litigation Wound Care | Comments Off on Three Common Reasons You Might Get Sued
Friday, July 14th, 2017
Nancy Collins, PhD, RDN, LD, FAPWCA, FAND
Nutrition is frequently conjoined to wound care lawsuits because patients often lose weight, so it is important to thoroughly document nutrition interventions and education.
Most pressure injury lawsuits begin as just that—a lawsuit initiated because of an acquired pressure injury. Usually the wound in question never healed to closure, became infected, led to an amputation, or otherwise caused the patient suffering. During the legal discovery process, all sorts of other care issues come to light, and the scope of the lawsuit grows. One of the most common additional issues is the patient’s nutritional status. Let’s look at it from both sides.
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Tags: Documentation, Dr. Nancy Collins, malnutrition, medico-legal, Nancy Collins, Nutrition
Posted in Nutrition, Wound Care | Comments Off on Nutrition and Wounds: The View From Both Sides
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.
“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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Tags: CMS standards, Dr. Nancy Collins, Legal Implications In Wound Care, medico-legal, Nancy Collins, Quality
Posted in Legal, Litigation Wound Care, Wound Care | Comments Off on Truth or Consequences: Admitting Your Wound Care Program Needs Improvement
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.
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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Tags: Defensive Documentation, Documentation, Dr. Nancy Collins, Legal Implications In Wound Care, medico-legal, Nancy Collins
Posted in Assessment, Legal, Litigation Wound Care, Wound Care | Comments Off on Nine Wound Care Documentation Pitfalls to Avoid
Friday, April 7th, 2017
Nancy Collins, PhD, RDN, LD, NWCC, FAND
Documentation of turning and repositioning often leads to legal problems as some healthcare providers chart by exception and others chart at the point of care.
Nancy Collins, PhD, RDN, LD, NWCC, FAND
“The hospital never turned the patient, and therefore the patient suffered a serious pressure injury,” declared the plaintiff attorney. The defense team shot back, “Whoa. Slow down. Never is long time, and of course we turned the patient.” How can a basic care intervention such as turning and repositioning have two totally opposing views?
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Tags: Defensive Documentation, Documentation, Dr. Nancy Collins, Nancy Collins, repositioning, turning frequency
Posted in Legal, Litigation Wound Care, pressure injuries, Wound Care | Comments Off on The Great (Legal) Debate About Turn and Reposition Documentation
Friday, March 3rd, 2017
Nancy Collins, PhD, RDN, LD, FAPWCA, FAND
Plaintiffs often express shock and disbelief after eschar is removed, which often leaves a wound larger than the original size of the eschar.
Wound photo: “Stage 4 decubitus displaying the Gluteus medius muscle attached to the crest of the ilium” by Bobjgalindo is licensed under CC BY 2.0
“We were in shock and couldn’t believe our eyes. It was like half her foot was gone.”
“My husband and I were horrified when we saw what they did.”
“My sister and I looked at each other, and I just kept asking why?”
“I had to leave the room and go the bathroom to cry when I saw what they did to my mother.”
You might think these quotes are from people who have witnessed a shocking crime or some sort of violence, but they are not. These are quotes from family members, now plaintiffs, who are suing for poor medical care related to a chronic wound. Their shock all had one thing in common—it came after seeing a wound that was surgically debrided.
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Tags: Debridement, Dr. Nancy Collins, eschar, medico-legal, Nancy Collins, Patient Communication, Sharp Debridement
Posted in Debridement, Legal, Litigation Wound Care, Wound Care | Comments Off on Disappointed by Debridement
Friday, February 3rd, 2017
Nancy Collins, PhD, RDN, LD, NWCC, FAND
The battle between optimal medical care and patient rights is one to fight with empathy and finesse to keep it out of the courtroom.
I recently reviewed a lawsuit filed by the family of a patient* with a spinal cord injury. The patient was involved in a car accident and sustained multiple traumatic injuries. The medical team worked tirelessly over the course of many weeks to stabilize him. Because of this catastrophic accident, the patient was understandably quite devastated and depressed. He refused all physical therapy and spent most days lying in bed on his back, despite encouragement from his medical team and pleading from his family. He frequently stated that he wished he was dead and that he wanted everyone to leave him alone, often escalating things to the point of screaming.
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Tags: Dr. Nancy Collins, Lawsuit, Legal Implications In Wound Care, medico-legal, Nancy Collins, Patient rights, positioning, turning frequency
Posted in Legal, Litigation Wound Care, pressure injuries, Wound Care | Comments Off on When Your Patient Refuses to Be Turned and Repositioned—And Then Sues!
