Pressure Ulcers

Margaret Heale's picture
nurse transporting patient in wheelchair

By Margaret Heale, RN, MSc, CWOCN

It has become quite easy to look at pressure ulcer prevention in most health care settings. From acute care, through the ED and on to the OR and ITU, then to the various floors of med surg, orthopedic, not forgetting rehab and community nursing. Pediatric and neonatal units have better defined pressure ulcer risk assessment tools to utilize that have made assessment and planning care much less haphazard for those patients than in the past.

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Laurie Swezey's picture
Wound Assessment Tools

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

There are many tools that can be used to assess wounds. It is important to be aware of these tools and what they measure. It is also important to become knowledgeable about the tool(s) used in your workplace.

Margaret Heale's picture
Accountability

By Margaret Heale, RN, MSc, CWOCN

Most of the residents here are elderly, though some of the more acute rehab patients are quite a bit younger than me. We actually have five women over a 100 out of 116 people, quite impressive with the eldest being 105 years old. As for me, I am a retired British matron just doing a little volunteer work near where my granddaughter works.

Cheryl Carver's picture
safety net

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

Substandard documentation tops the list of mistakes for long-term care facilities. It involves "all hands in the chart" so to speak. This encompasses all disciplines, from the nursing assistant to the physician. Discrepancies and gaps in documentation put your facility at risk of litigation. Impeccable documentation is essential in defending any case. Your facility must have a "safety net" in place. This "safety net" consists of educating staff about the importance of timely and detailed documentation not only for the facility, but for their license. Often times, clinicians are not aware of the legal repercussions of their actions. Surveyors will also consider other related Federal Tags (F-Tags) during investigations for compliance.

Mary Ellen Posthauer's picture
Nutrition

By Mary Ellen Posthauer RDN, CD, LD, FAND

When I attend wound care conferences both nationally and internationally, I am frequently asked how I became interested in nutrition and wound care. In 1995, I was involved in a quality assurance project for the Academy of Nutrition and Dietetics – previously known as the American Dietetics Association (ADA) – examining clinical indicators associated with unintentional weight loss and pressure ulcers in elderly residents in nursing homes. The result of study was published in the ADA Journal and noted the relationship between unintended weight loss, poor dietary intake and pressure ulcers.

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Aletha Tippett MD's picture
Braden Scale

By Aletha Tippett MD

I was recently asked to speak on best practices for prevention of pressure ulcers for a group of state surveyors. This is an excellent subject and here is how I would address it:

Lindsay Andronaco's picture
depression

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

I have been in wound care my entire nursing career. I have been in a variety of positions, but it always involved wound management. It wasn't until recently that I became more interested in pressure ulcers than I ever thought possible. A close friend of mine, "Karla", was diagnosed with a rare condition that left her basically paralyzed from the waist down. Karla is an extremely intelligent, independent, successful young woman who woke up one day and couldn't feel her feet due to her condition. The progression of the paralysis was rapid, but luckily seemed to have stopped about waist high.

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Mary Ellen Posthauer's picture
medical records

By Mary Ellen Posthauer RDN, CD, LD, FAND

As Dr. Aletha Tippett noted in her December blog, following wound documentation standards can help clinicians avoid legal issues. Pressure ulcer litigation often involves pressure ulcers and weight loss.

WoundSource Editors's picture

By the WoundSource Editors

Litigation over hospital-acquired pressure ulcers represents a significant fraction of a medical malpractice attorney's caseload. The liability issues have shifted since October 1, 2008 when the Centers for Medicare and Medicaid Services and several private payers began denying reimbursement for care related to hospital-acquired stage III and IV pressure ulcer. Prior to October 2008, the experts battled over whether a pressure ulcer was avoidable. Now, they still do, but plaintiff attorneys and their experts can point to the government's stance that pressure ulcers are avoidable, "never events". Defense experts must assert that everything possible was done to avoid the ulcer, or it was not really caused by pressure.

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Cheryl Carver's picture

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

As a traveling wound care educator for physicians, I am observing many changes within the state survey process for long-term care. Wound care physicians working in long-term care are feeling the same anxiety that facility leaders and staff members are, as the time nears the window for an annual state survey.