Wound Care Risk Management Posts

Archive for the ‘Wound Care Risk Management’ Category

Why Wound Care Matters

Wednesday, July 27th, 2022

Wound care is essential in nearly every care setting, affecting patients across the care continuum. Understanding why wound care matters to both patients and caregivers alike is key, as wounds can prolong hospital stays, increase the risk of infection, and quickly raise costs for healthcare facilities.

A common issue requiring wound care is pressure injuries, which affect 1 to 3 million people per year in the U.S. alone. While pressure injuries occur in most care environments, they are particularly prevalent in both long-term and post-acute care environments — including hospice and home health settings — where patients remain sedentary for extensive periods of time. As the median age of the U.S. population continues to rise, an increasing number of people require wound care services, including treatment for pressure injuries.

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All About the Braden Scale for Predicting Pressure Injury Risk

Monday, February 14th, 2022

As we shifted from “turning Q 2 hours” for positioning our patients to “individualized positioning based on tissue tolerance,” many clinicians were unsure how best to establish a plan of care.

How do we determine the positioning frequency? What is the pressure injury risk for our patients? How can we quantify risk to drive plan of care for positioning?

The Braden Scale for Predicting Pressure Ulcer/Sore Risk is a great tool to assist with those questions.

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Posted in Clinical - Conditions, Pressure Injuries, Specialties, Wound Care Risk Management | Comments Off on All About the Braden Scale for Predicting Pressure Injury Risk

State Practice Act Liability Affects All Members of Wound Care Team

Wednesday, November 25th, 2020

Potential liability under your state practice act is something to always be aware of.

If you face an alleged violation of your practice act, professional disciplinary action can be initiated by the applicable board that administers and enforces the act.

Disciplinary actions are determined by each professional board such as the board of medicine, board of physical therapy, occupational therapy board, or board of nursing.

Professional disciplinary decisions are public records, and most state boards provide online access to them.

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Legal Case Highlights Importance of Wound Care Documentation

Wednesday, November 4th, 2020

We have discussed the importance of nurse expert testimony in cases alleging professional negligence against you.

One blog addressed a breach of your standard of care when providing wound care.

A second reviewed the importance of your wound care documentation in the patient’s medical record.

This article takes a look at the 2016 case, Henson v. Grenada Lake Medical Center, to underscore both of these important points.

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Nursing Documentation in Wound Care Is a Key Factor in Determining Liability

Thursday, August 13th, 2020

The medical record is an essential piece of evidence in any legal case alleging professional negligence against wound care nurses and others.

As you know, one of the purposes of the medical record is to reflect what nursing care was given to the patient. The entries speak to the quality of the care given.

The entries are supplemented by oral testimony at trial of those whose notations are in the medical record. A jury then decides if care was given that meets the standard of care in the situation or if the caregiver failed to meet his or her legal obligation.

The following 2020 legal court decision (Nixon v. The Brookdale Hospital Medical Center, Parkshore Health Care, LLC, Four Seasons Nursing and Rehabilitation Center, and the New York Community Hospital of Brooklyn, Inc.), illustrates the importance of nursing documentation and potential liability for patient injuries and death.

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Your State Nurse Practice Act Can Dictate Wound Care Liability

Wednesday, June 17th, 2020

I received a question about an RN who was practicing in a “wound center.”

She received notice from her state board of nursing that a complaint had been filed concerning her treatment of a patient’s wound.

According to the RN, a substitute physician saw her patient one week. He told the patient and a family member that Tegaderm should not have been used on the wound.

In addition, the substitute physician said there were two wounds — not one — and the second had not been treated.

The RN stressed the following:

There was only one wound
The substitute doctor was incorrect
The patient’s regular physician had been seeing the patient for some time and knew there was only one wound
She was upset about the complaint
Had to hire an attorney to represent her before the board
She believes the physician defamed her and should pay her attorney fees

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Ability of Patient to Provide Own Ostomy Care Called into Question

Wednesday, May 27th, 2020

As a wound care nurse, you teach your patients how to care for their wounds, including a colostomy.

You teach them as they observe treatments you provide, such as ostomy care, while they are at a clinic.

It also includes orally reciting your care as you carry out treatment and direct the patient. This empowers them to understand what is required for appropriate personal care.

You also might write down instructions and diagrams about required treatment that patients can take home and reference.

The teach-back method of patient instruction incorporates both of these approaches. This is when you have the patient repeat back what you instruct and demonstrate the care you described.

Any patient teaching also requires that the patient comprehend your:

Demonstration of care
Verbal instructions
Ability to carry out the treatment

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Hyperbaric Oxygen Therapy Case: Liability Can Result from Treatment Inaction

Wednesday, March 25th, 2020

Many of you have worked with wound care patients needing antibiotics and hyperbaric oxygen therapy.

In the 2016 Texas case of Gonzalez v. Padilla, the issue of whether the antibiotics or hyperbaric oxygen therapy were properly prescribed was a core issue in the case.

The patient was struck while riding his motorcycle and was taken to a university-based medical center with a broken lower right leg and a de-gloved heel.

An open external fixation procedure of his compound, comminuted fracture was successfully performed and a “halo type” fixation device was placed around the leg to hold the bones in place as the fracture healed.

The patient was also placed on IV antibiotics, including Gentamicin and Cefazonlin for a period of five days. In addition, he received daily wound care treatments.

The medical center’s records indicated his right leg showed “obvious evidence of continued blood flow … and no obvious necrosis beneath the heel tissue itself.”

Posted in Adjunctive Modalities, Skin & Wound Management, Wound Care Risk Management | Comments Off on Hyperbaric Oxygen Therapy Case: Liability Can Result from Treatment Inaction

What Does an Allegation of Ordinary Negligence Mean?

Thursday, March 5th, 2020

When you are named in a lawsuit alleging professional negligence, a requirement calls for a nurse expert.

The nurse expert is called for both parties (plaintiff and defendant) to establish whether the applicable standard of care in the situation was met or was breached.

The requirement of a nurse expert witness to establish whether the standard of care is met is based on the fact that an allegation of professional nursing negligence involves nursing judgment in the care of a particular patient.

The overall standard of care in a professional negligence case against a nurse is what ordinary, reasonable and prudent nurses would have done in the same or similar circumstances.

The establishment of what you as a wound care nurse would have done in a particular case requires, as the court below stated, “highly specialized expert knowledge with respect to which a layman can have no knowledge at all, and the court and jury must be dependent on expert advice.”

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Prior Authorization: New Rule in Effect for Pressure Reducing Support Surfaces

Wednesday, February 26th, 2020

Clinicians caring for Medicare beneficiaries who need pressure reducing support surfaces when discharged home are adapting to a new rule.

Those clinicians now need to submit a Prior Authorization Request for Pressure-Reducing Support Surfaces, said Cynthia Broadus, BSHA, RN, CHCRM, LNHA, CLNC, WCC, DWC, OMS, executive director at the National Alliance of Wound Care and Ostomy (NAWCO) in Somonauk, Ill.

The Prior Authorization Request for Pressure Reducing Support Surfaces is a rule established by the Centers for Medicare and Medicaid Services (CMS) that took effect Oct. 21, 2019.

Submitting the preauthorization documentation will identify the need for the pressure reducing support surface and provide the supporting documentation, according to Broadus.

“The authorization must be submitted before the support surface is supplied to the patient and before a claim can be submitted for payment,” she said.

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