Article Title: Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study
Authors: Artico M, D’Angelo D, Piredda M, et al
Journal: J Pain Symptom...
By Karen Zulkowski DNS, RN, CWS
Last month I talked about the issues that occurred during my husband’s knee surgery. This month I want to bring the focus back to lawsuits and how they arise. What are the implications for the patient and family, and how does palliative wound care fit in?
First, families often get the idea that the care of their loved one was inadequate from a simple comment made by the medical staff treating them. From the ER, “Wow - she didn’t look that bad when we sent her to the nursing home”. From the nursing home, “They didn’t tell us she had a pressure ulcer before they sent her here”. Let’s be realistic. If the individual was healthy to begin with, they wouldn’t need to go to a nursing home. Additionally, long transportation times to the hospital and long ER/OR times may lead to a pressure ulcer even before the person was placed on a nursing unit. Short hospital stays mean the wound shows up in all its glory at about the time of transfer from acute care to the nursing home.
Next, if the individual was doing so well they wouldn’t need to go back to the acute care setting from the nursing home. This is a big concern. A patient in declining health is at high risk of developing pressure ulcers and those ulcers do not heal. The same is true for palliative care patients. We treat the ulcer the same, but our goal is maintenance as much as possible - not healing.
So what do we do? First, we communicate. This is not only staff-to-staff, but staff-to-family and everyone-to-patient. Find out if your facility has information that is given to the patient and family. Think about how what is being said about the individual’s care sounds to the patient and family. Suppose the patient’s daughter says to the attending CNA that she noticed Mom’s bottom was red and “how did this happen and what are you doing for it?”, and the CNA answers, “I don’t know”, it sounds like no one was aware of the problem. If the CNA says “Let me get the best person to talk to you about it” and goes and gets the RN or wound nurse, the perception is that everyone knows all about the patient’s condition and they are providing the best care. Enlist the family’s help by asking them to get involved in care. Suggest, “We need your Mom to move around. Can you help us when you are visiting by encouraging her to move in bed?” Learn to be proactive rather than reactive to skin care and wound prevention.
Finally, what about my husband’s knee surgery case? A hospital representative came to his room and apologized for the mix-up. They assured us that there were no charges for anything and they were very concerned about the problems. This is a good example of being proactive. They apologized, paid for his care and since no lasting harm was done, it would mitigate a potential lawsuit. Remember: you need to show injury so a proactive approach was smart.
Let’s take that approach to the health care staff level. Communicate with each other and the patient and family. If a pressure ulcer (skin tear, etc.) develops, tell the family and patient about it and what you are doing to for it. Finally, think about what you are saying from the perspective of the family and patient.
About The Author
Karen Zulkowski DNS, RN, CWS is an Associate Professor with Montana State University-Bozeman, teaches an online wound course for Excelsior College, and is a consultant for Mountain Pacific Quality Improvement Organization. She has served as a Research Consultant with Billings Clinic Center on Aging, and was the Associate Director for Yale University’s Program for the Advancement of Chronic Wound Care.
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.