Posts Tagged ‘Dr. Nancy Collins’
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!
Friday, December 30th, 2016
Did you miss any WCEI blogs? Never fear, we wrap up the year with the topics that were most read, shared, and commented upon.
In 2016, we covered a lot of ground, bringing you straight talk on range of wound care topics, including ostomy care, diabetic wounds, legal issues, assessment tips, and more. Which were readers’ top five favorites? Here’s the run-down.
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Tags: 2016, Dr. Nancy Collins, exudate, exudate type, Maceration, Ostomy, Top Blogs, wound care myths, Wound Photography, Wound Photos
Posted in Litigation Wound Care, OSTOMY, Wound and Skin Management, Wound Care, Wound Photography | Comments Off on Your Favorite WCEI Blogs of 2016
Friday, December 16th, 2016
Nancy Collins, PhD, RDN, LD, FAPWCA, FAND
The new year is quickly approaching, and most of us are reflecting and setting goals for 2017. Here’s a simple plan that outlines what you must do to minimize the risks of practice.
As wound care practitioners, our main goal is to heal wounds as quickly and painlessly as possible. Over the years, this simple mission has gotten tied up in countless legal matters as disappointed patients and their families turn to attorneys when things don’t work out. Follow this outline of what to do to minimize the risks of practice in the new year.
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Tags: dietician, Dr. Nancy Collins, Lawsuit, legal, Litigation, medico-legal, Patient Communication, Wound Care
Posted in Education, Legal, Litigation Wound Care, Wound Care | Comments Off on The RATS of Malpractice: Don’t Let Them Invade Your Wound Care Practice!
Friday, November 4th, 2016
Nancy Collins, PhD, RDN, LD, FAPWCA, FAND
Clearly it is a legal liability when health care professionals (HCPs) do not follow doctor’s orders. But when the patient chooses not to follow doctor’s orders, things are not so clear.
Most of the lawsuits I deal with have more than one named defendant. For example, the plaintiff (typically a deceased patient’s next of kin) might sue a hospital, a nursing home, and the attending physician at each facility. Sometimes they go a bit further and may even include the administrator, the director of nursing, and individual HCPs, such as the wound care nurse or the registered dietitian nutritionist.
When a lawsuit has multiple defendants, one of the main tasks is determining how much responsibility for the outcome to assign to each party. Responsibility is a nice word for blame, because that is really what we are talking about. Each defendant’s attorney will argue that their client is not to blame, which is obviously their job. What is not so obvious is that this means the attorney must deflect the blame to one of the other parties. It is truly every defendant for himself or herself.
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Tags: dietician, Dr. Nancy Collins, Lawsuit, legal, Litigation, medico-legal, Patient Communication, Wound Care
Posted in Legal, Litigation Wound Care, Wound Care | Comments Off on The Blame Game: Is It All Right to Blame the Patient?
Friday, October 7th, 2016
Nancy Collins, PhD, RDN, LDN, FAPWCA, FAND
Inaccurate and incomplete intake and output (I&O) records pose a problem in litigation, as well as a risk to the patient who requires monitoring of fluid balance for medical reasons.
“Would you agree that the nurses did not know how to do basic arithmetic?”
Of course nurses know how to add and subtract, yet I was asked this question in a very challenging manner by a plaintiff attorney. He had just showed me 3 weeks of I&O tables excerpted from the medical chart of the deceased plaintiff, and almost every shift was incomplete. The plaintiff attorney was reducing the problem to poor math skills, implying that not a single day was complete because the nurses who cared for this patient lacked the skills to add a column of numbers. He knew I would disagree because I was not going to say these nurses lacked basic math skills. But he also knew his follow-up question was the real reason for this math ploy.
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Tags: Documentation, Dr. Nancy Collins, Legal Implications In Wound Care, Medical Records, Nancy Collins, Patient Care
Posted in Legal, Litigation Wound Care, Wound Care | Comments Off on Intake + Output = Big Documentation Problems
