Archive for the ‘Legal’ Category

Retained surgical bodies can lead to serious wounds

Tuesday, November 19th, 2019
A surgeon checks a wound for retained surgical bodies.

Retained surgical bodies in a patient postop is not an unfamiliar occurrence.

One literature review indicated that with more than 28 million operations in the U.S. nationwide, 1,500 estimated cases per year of retained surgical bodies left in patients take place.

In the 2016 case of Thompson v. Mangham Home Care, Inc., who left gauze in a patient’s surgical wound was at issue.

The patient saw her primary care physician for boils/sores on both of her buttocks in 2008.

The primary doctor prescribed antibiotics without success, and the patient was referred to a general surgeon who treated the condition with antibiotics and warm soaks.

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Wound photos can help determine a clinician’s legal liability

Wednesday, October 16th, 2019
A clinician documents wound photos on a company phone.

In many instances, wound care involves pressure wounds, such as decubiti and poor vascular conditions, such as diabetic foot wounds.

In the following case, the improper administration of chemotherapy agents through an IV line caused a wound that resulted in severe pain and limited the use of two fingers on the patient’s non-dominant hand.

Key evidence in the trial were wound photos of the open wound that occurred because of the negligent administration of chemotherapy by two nurses who were named defendants in the suit — Iacano v. St. Peter’s Medical Center.

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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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Learn why many organizations need a wound expert today

Monday, June 17th, 2019

wound expert

Organizations need for trained wound experts is on the rise.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

The reasons for this increase are multifactorial, said wound expert Nancy Morgan, MBA, BSN, RN, WOC, WCC, DWC, OMS, cofounder and clinical consultant with the Wound Care Education Institute.

We sat down with Morgan to learn why more patients than ever need expert wound care.

Q: What role do chronic diseases play in creating a need for wound care?

People are living longer with chronic diseases such as diabetes and obesity, which predisposes these patients to the development of chronic wounds.

Chronic wounds require treatment with the skills of knowledge of wound experts over the course of several weeks, months and sometimes years.

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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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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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