Archive for the ‘Wound Care Risk Management’ Category

Nurse Expert Witness Impacts Pressure Injury Case

Monday, August 5th, 2019

nurse expert witness

Many of you have provided expert testimony in lawsuits in your own state, or other states, concerning wound care and whether that care was consistent with the applicable standard of care and standards of practice in that situation.

wound care

By Nancy J. Brent, MS, JD, RN

The following Arizona case — Rasor and Donald Miller, Wife and Husband, v. Northwest Hospital LLC — determined if a wound care nurse expert could testify to the cause of a wound sustained by the plaintiff (patient).

The female patient had open-heart surgery at the hospital and received an intra-aortic balloon pump “threatened through her femoral artery.” This required immobilization of her leg.

The patient was in the ICU for several days and the nursing staff discovered a pressure injury on her coccyx that reached stage IV and required 31 debridement procedures.

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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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How to Persuade Clinicians to Change a Wound Care Order

Tuesday, July 9th, 2019

wound care order

How can you convince an ordering clinician to consider a more effective wound treatment? Psychology offers some clues.

By Keisha Smith, MA, CWCMS

If you’re a knowledgeable, certified wound care clinician, receiving an outdated or illogical wound care order can be frustrating.

So, what can you do when you’re tasked with administering treatments you believe will be ineffective or harmful to a patient?

First, practicing substandard wound care can land you in legal hot water, even if you are following orders.

To protect your license, reputation and financial well-being, you need to speak up about wound care orders that contradict your knowledge and training.

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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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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…)

What Would You Do if Your Patient Chokes?

Friday, August 31st, 2018

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

Every minute counts when a patient chokes, so you must react confidently and have a plan in place to handle this emergency situation.

Dr Nancy Collins

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

John Quiñones stars in the ABC television show What Would You . The program features actors cast in scenes of conflict or illegal activity in public settings, while hidden cameras record the situation. The focus of the show is to see whether ordinary people intervene or just pass by and how they react. For example, a recent episode featured a young girl’s nanny berating her in public and calling her stupid. Several passersby asked the nanny to cool it, while others just squirmed and silently hurried by. The point of the show is that we never really know how we will react to a situation until we are actually in it, and then each of us has to make a choice.

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Can You Use Job Burnout as a Legal Defense?

Friday, November 10th, 2017

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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