Assessing Wound Management Standards for ICU Patients Transferred to Skilled Nursing Facilities

This case study examines a situation where an ICU patient developed a large coccygeal ulcer after being transferred to a skilled nursing facility, leading to sepsis.

Expert Institute

Written by Expert Institute

- Published on November 6, 2023

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Case Overview

In this case study, we examine the situation of an adult patient who was initially hospitalized due to COVID-19. After receiving intubation, the patient spent over a month in the Intensive Care Unit (ICU). This was followed by a transfer to a skilled nursing facility.

The patient was found to have developed a large coccygeal ulcer upon arrival at the facility. Sepsis developed as a result of this wound becoming infected. The patient required extended treatment at the facility due to sepsis. There is a question of whether the standard of care regarding wound prevention and management was breached in this case.

Questions to the Wound Care expert and their responses


How often do you care for patients in the ICU and manage wound care in a hospital setting?

As an expert in wound care and emergency medicine, I have frequently provided care for patients in various settings including acute care hospitals, long-term acute care hospitals, skilled nursing facilities, and outpatient clinics.

My experience extends to supervising nurses as the medical director of both a long-term acute care hospital wound care center and a hospital-based outpatient wound care program. I also supervise nurses in my private outpatient wound care practice.


How can pressure ulcers be prevented for ICU patients?

Pressure ulcer prevention involves identifying high-risk patients using tools like the Braden scoring system. Once these individuals are identified, preventive measures include frequent turning of the patient, use of appropriate support surfaces, regular changing of dressings, ensuring adequate nutritional support, and dressing changes.

About the expert

This expert brings over three decades of experience in emergency medicine and wound care, with board certification in both areas. They have held numerous roles including a clinical instructor of emergency medicine at a renowned university, the director of wound care and hyperbaric medicine at a regional medical center. They currently serve as a wound care physician at a medical center in California. Their extensive background, coupled with active memberships in professional organizations like the Wound Healing Society, makes them highly qualified to provide insights on cases involving wound management in ICU settings.

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