I would not be not surprised if you said, “More often than I would like.” Unfortunately, that is the reality for wound care specialists today.
According to a 2018 BMJ Open article, nurse researchers found an overuse of wound treatments with limited evidence and low value. They also found an underuse of evidence-based treatments.
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As a wound care nurse, you know hand hygiene is essential in preventing infections when providing patient care, as we discuss in the blog post “The Case of the Dirty Wound Care Clinic.”
If you provide care outside of the traditional clinical settings, such as a hospital or a wound care clinic, you know how difficult it can be to maintain good hand hygiene. Without running water, gloves or sanitizer, the risk of infection or its spread is evident.
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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:
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:
You can find an abundance of information, research and articles on continued competence, whether the topic is:
One definition of competence is the quality or state of having sufficient knowledge, judgment, skill or strength (as for a particular duty or in a particular respect).
Another definition describes competence as the quality of being competent — adequacy; the possession of required skill, judgment, qualification or capacity.
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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.”
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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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The costs of pressure injuries are numerous, but one area of major concern is when their existence results in a lawsuit. These suits typically allege the pressure injury was the result of poor nursing and overall care of the patient and/or resulted in a patient’s death.
Jacqueline Genesio identifies several lawsuits that resulted in significant verdicts in the article “Pressure Ulcers Are Easy Pickings For Lawsuits.”
As she points out, not only can a verdict result in compensatory damages (money paid to compensate the patient for pain and suffering and lost wages, as examples), but also can include punitive damages.
In one 2015 case, Genesio reported an Arizona jury awarded $2.5 million in compensatory damages and $16.7 million in punitive damages to the estate of an 86-year-old woman.
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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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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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