Heidi Cross's blog

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

Given the potential consequences of FTT, recognition and diagnosis of this phenomenon are important components of care in older adults. Regardless of status, health care providers should implement and document all appropriate measures within patient goals of care. One of the key factors in lawsuits is a lack of communication with family members, who maintain that they were not informed in a timely manner about their loved one’s health status and prognosis.

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

In medical malpractice litigation, a thorough review of the medical chart is done to determine whether the facility or health care provider “met the standards of care” related to the medical issues at hand in the complaint. Attorneys hire specialists in the field to serve as expert witnesses to make this determination. Whether the case is settled or goes to trial, if the facility can show that it met most if not all standards of care, then the defense prevails. If not, the plaintiff has proved neglect with a breach of duty and receives compensation.

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

The United States is one of the most litigious nations in the world, with the result that numerous medical malpractice lawsuits are initiated against hospitals and other health care facilities, as well as practitioners. Commonly, these lawsuits allege that the facility failed to meet standards of care related to management of wounds including pressure injuries, failed to provide adequate nutrition, and did not properly address issues such as incontinence.

I have been there, done that. Sitting in the fact witness chair in front of a plaintiff attorney who is wildly waving a copy of my facility’s wound care policy and procedure, demanding to know why certain things weren’t included in the policy, and why what was in the policy was not followed to the letter. Plaintiff attorneys have the right to demand copies of a facility’s policy and procedures as part of discovery and will go through them with a fine-tooth comb, compare what is in the policy with the care that was provided, and fault the facility for any deviations. It goes without saying that I promptly returned to my facility with a new understanding for how our policy was written and possible gaps and weaknesses.

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

As detailed in my last few blogs, nutrition plays a huge role in risk for skin breakdown as well as healing of wounds. Just about ALL wound litigation involves nutrition in one way or another, be it diabetes control (or lack thereof) or weight loss, which occurs often in patients with dementia and toward end of life, or general malnutrition.

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

The following is a wrap up of the 2019 pressure injury guidelines of the National Pressure Injury Advisory Panel (NPIAP)¹ related to nutrition, of which there are 15. For guidelines #1 to #10, see my last few blogs (Parts 1, 2, 3 of this blog series).

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

Since the advent of coronavirus disease 2019 (COVID-19), I haven’t done much flying, but I love travel and I love flying. One of my favorite experiences is a window seat at about 30,000 feet on a clear sunny day. The views can be spectacular – whether flying across the Rockies or the Plains or any of the stunning and varied scenery of this country or the world. A couple of my most memorable flights involved flying into New York City with views of the New York skyline with Lady Liberty in clear sight, or into Washington, DC with clear views of the Mall, the Jefferson Monument, and the Capitol. The Alps and the Rockies are incredibly awe-inspiring, beautiful, and breathtaking. From there, you get a good overall picture of the landscape.

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

"Defendants failed to provide adequate nutrition to prevent plaintiff from suffering severe malnutrition and weight loss. This allowed the development of a severe pressure ulcer, numerous infections, and dehydration and malnutrition. Had defendants provided proper care, the pressure ulcer, infections, and malnutrition and dehydration would not have occurred."

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

In the previous blog, I briefly went through the standards of care when it comes to nutrition and pressure injury (PI) prevention and development and discussed what a large role nutrition plays in PI litigation. Here are several instances: Punitive damages of $92 million, later lowered to $11,855,000, were imposed where malnutrition and dehydration were proven against a nursing home. A dietary manager for a nursing home told state surveyors that her nursing home had "dropped the ball" on a resident's nutrition needs when that resident had lost 17 pounds in 75 days; a $1,385,000 settlement was reached. Malnutrition with a loss of 27% of body weight in 15 months led to a $380,000 settlement just before trial. Shocking, isn't it? It literally "pays" to pay attention to nutrition standards of care.

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

Pressure injury risk and development are multifactorial, individualized processes. Each patient presents with a unique set of circumstances and needs. In looking at charts for attorneys to determine whether standards of care related to pressure injuries have been met, key elements include turning and positioning measures, support surfaces, mobility, proper and timely assessment of risk factors and wounds, physician communication and notifications, communication with family, proper wound treatments, and nutrition assessment and measures.