"Among the duties the defendants and their employees owed to Mr. JD but failed to perform was the duty to timely, accurately, and adequately assess his risk for skin breakdown and the development of a pressure ulcer."
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 pressure ulcer 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 pressure ulcer 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? The most commonly used scale in the United States is the Braden Scale for Predicting Pressure Sore Risk.1 Developed in 1987 by Barbara Braden and Nancy Bergstrom, it has been extensively tested for reliability and validity. Used correctly and completed as designed, it is an excellent metric for the risk of skin breakdown.
The 2014 National Pressure Ulcer Advisory Panel (NPUAP) Guidelines state, "Conduct a structured risk assessment as soon as possible (but within a maximum of eight hours after admission) to identify individuals at risk," "Repeat the risk assessment as often as required by the individual's acuity," and "Undertake a reassessment if there is any significant change in the individual's condition."2 The Guidelines also include recommendations about documentation and developing a plan.
So, what can go wrong relative to subscores?
Conducting the Braden Scale is only the beginning and, unless translated into action, will amount only to busywork on the part of the nurses. Based on the subscores, an individualized and evidence-based care plan needs to be implemented, with interventions specifically targeted at needed areas. This is something that attorneys actively scrutinize!
1. Prevention Plus . Braden Scale for Predicting Pressure Sore Risk. www.bradenscale.com. Accessed December 12, 2018.
2. National Pressure Ulcer Advisory Panel (NPUAP). Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Washington, DC: NPUAP; 2014. Available at http ://www.npuap.org/resources/educational-and-clinical-resources/prevention-a…. Accessed December 12, 2018.
About the Author
Heidi H. Cross, MSN, RN, FNP-BC, CWON, is a certified Wound and Ostomy Nurse in Syracuse, NY. She has extensive experience caring for wound and ostomy patients in acute care as well as in long term care facilities. Currently, she is employed by CNY Surgical Physicians consulting for nursing homes in the Syracuse area, and has served as an expert witness for plaintiff and defense attorneys.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.