Legal Issues

Heidi Cross's picture
Pain and Suffering Documentation

Heidi Cross, MSN, RN, FNP-BC, CWON

"Me and Jenny goes together like peas and carrots." – Forrest Gump

Just like Forrest's peas and carrots, a pressure ulcer lawsuit and a pain and suffering allegation inevitably "goes together." For good reason, because pain is an ever-present problem in patients with pressure ulcers, venous and arterial ulcers, and even diabetic ulcers, despite sensory issues. How do you, as a health care provider, best protect and defend yourself against a pain and suffering allegation?

Heidi Cross's picture
Unavoidable Pressure Ulcers

By Heidi Cross, MSN, RN, FNP-BC, CWON

"At all times material hereto, defendant failed to develop an adequate care plan and properly monitor and supervise the care and treatment in order to prevent her from suffering the development and deterioration of bed sores."

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Risk Factors for Unavoidable Ulcers

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

According to the Agency for Healthcare Research and Quality, more than 17,000 lawsuits related to pressure ulcers (PUs) are filed annually in the United States, second only to wrongful death lawsuits. One of the greatest gifts to defense attorneys was when the Centers for Medicare & Medicaid Services (CMS) published F-Tag 314, finally acknowledging that some ulcers can occur despite best care. The facility essentially can maintain, “Hey, we did everything we were supposed to, and despite that, the patient developed that pressure ulcer”—that is, the ulcer was unavoidable. To prove unavoidability, proper documentation (proof) of best care needs to be in place, as well as documentation that all proper prevention and treatment measures were implemented.

Janet Wolfson's picture
The Lymphedema Treatment Act

by Janet Wolfson, PT, CLWT, CWS, CLT-LANA

As the 116th Congress ruffles its feathers and dusts out the corners, it's another chance for the Lymphedema Treatment Act (LTA) to become law. The Senate bill was given bill number S 518, whereas the House bill is pending. In the previous Congress, the bill had a super majority support in both Senate and House. One can only speculate what else might have consumed their time.

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Heidi Cross's picture
Skin Changes at Life's End

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

"If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed sore, it is generally the fault not of the disease, but of the nursing." —Florence Nightingale

Ouch! What an indictment of nursing and, by extension, the facility in which the nurse works. We have a lot to thank Florence Nightingale for—a brilliant woman considered to be the founder of nursing and nursing standards and the first to ever put statistics to health care, among other valuable contributions.

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Risk Assessment

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

When looking at medical charts from a legal perspective, one of the areas closely scrutinized is the risk assessment for skin breakdown and pressure ulcer development. Completing a risk assessment is considered a standard of care. Was the patient adequately assessed, and was this done in a timely fashion? Was it repeated at regular intervals, with a change in condition, or on readmission? Do scores seem appropriate for the patient's condition? Is there consistency among health practitioners? Were the results used to institute evidence-based and appropriate prevention and treatment measures and care plans? Or do the results seem to simply languish in the chart? What are the standards of care related to this?

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Heidi Cross's picture
Turning and Positioning

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

Failure to T&P (turn and position) is always part and parcel of a pressure ulcer lawsuit and a key element of a complaint related to pressure ulcers, as illustrated in the opening quotation. T&P documentation is a dominant focus in chart analysis and is usually one of the first things that an attorney and the expert witness look for. If T&P documentation is satisfactory, the defendant is likely to prevail; if not, then the plaintiff may have a pretty rock-solid case. But as I have opined in previous blogs, is there such a thing as perfect documentation? Alas...NO! (Or at least, rarely.)

Cheryl Carver's picture
Terminology

By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

It is 2018, and health care professionals around the world are still debating what to call skin damage. I totally immersed myself in wound care because of losing my 47-year-old mother to what was then called "decubitus ulcers." I was young when my mother died, and I wanted to know why and how this could happen. My perspective is different from that of most clinicians because of my personal experience.

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Heidi Cross's picture
Legal Issues

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

Part 2 in a multi-part series looking at the basics of avoiding litigation as a health care provider. Read Part 1 Here.

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