by Heidi H. Cross, MSN, RN, FNP-BC, CWON
Part 1 in a multi-part series looking at the basics of avoiding litigation as a health care provider.
by Rick Hall, BA, RN, CWON
Wound care documentation is a hot topic with overseeing agencies dealing with the medical industry. Good documentation is imperative to protect all those giving care to patients. Documentation should be egible, ccurate, hole, ubstantiated, naltered, ntelligible and imely. If these components are not incorporated into your wound care documentation, you could end up in a .
With some patients, families and attorneys looking for a way to attain capital gain, we health care providers must protect ourselves and the facilities we work for.
With End Of Life (EOL) wounds, more careful documentation is necessary. The National Pressure Ulcer Advisory Panel has provided in their Quick Reference Guide under Pressure Redistribution a number of guidelines that include turning and repositioning individuals based on his or her wishes, and as tolerated at periodic intervals. Comfort of individuals with EOL wounds is of great importance. Flexible repositioning schedules should be established based on the individual's preferences and tolerance, along with factoring in support surface characteristics for redistributing pressure.
Other guidelines for EOL wounds include pre-medicating individuals with significant pain on movement 20-30 minutes prior to his or her scheduled position change. Close observation of turning choice, including whether the individual has a "position of comfort" with an explanation of the basis for this positioning is also important to note. In managing the EOL wounds of individuals who are actively dying or who have conditions which confine them to single position of comfort, delivering care that affords comfort may supersede pressure ulcer prevention measures.
Clearly documenting the turning and repositioning of individuals with EOL wounds, including the rationale and factors impacting the decisions made for their care – including the factors addressed – is critical to providing comprehensive documentation.
A phenomenal skin condition might occur during a person's end of life. This condition has been named "Kennedy Terminal Ulcer" (KTU). The etiology of the KTU is unknown and more research needs to be conducted to understand this condition (see my blog for more on the KTU). The KTU is a condition some people get when they are at the end of life. Not all individuals have these phenomena happen but when it does, it is devastating to all involved. It can happen even though everything was done to prevent pressure ulcers, including turning and repositioning, as well as use of a proper support surface which offloads pressure on the body. Check labs and other documents as to other organs shutting down. Pre-albumin is important to check because albumin is what keeps the fluids in the vascular system. Usually the pre-albumin is below 10 and often 5 or less in individuals actively dying. As I recently discussed in my blog, I believe this condition to be lividity prior to death, not a pressure ulcer as we have named it.
With a precedent now set by the state of Wisconsin, caregivers are also at risk for a lawsuit. Caregivers should document interventions they have done in the care given to their loved ones, which includes documenting assistance from an outside source. Include dates of contact, in addition to the source(s) of assistance and interventions performed.
About the Author
Rick Hall is a wound and ostomy educator and consultant for Kaiser Permanente.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.