This case takes place in Tennessee and involves an obese female patient who underwent extensive surgery on her bowels. She was discharged to a nursing facility post operatively in order to recover. Some time after being admitted, a small lesion was noted on the patient’s back. An order was made for the patient to be rotated regularly in order to prevent further damage, however the notes indicate that this was not done. Eventually the patient was also placed in restrains, which prevented her from moving on her own. Some time late, several lesions were noted on the patient’s back. Wound care was consulted and made a notes to follow up with the patient. The wounds were only evaluated sporadically from that point forward. Eventually, the patient’s lesions became serious enough to require surgical treatment. Nevertheless, the patient ultimately succumbed to infections caused by the pressure wounds.
Expert Witness Response E-022168
My initial thoughts are that it is very hard to prove whether a patient has been turned in a timely manner as the documentation is rarely there to substantiate it. A patient who is obese and restrained would also be very high risk for pressure ulcer development given the poor mobility and would require several prevention interventions. Wound evaluation every 3-4 days is adequate as long as the appropriate dressing is being used. There are wound dressings that are approved for 3-7 days of wear time. As always however, all pressure ulcers are preventable and none are excusable. Standard of care must have been breached to allow it to get to a stage IV and septic. *Yes, I treat many patients with pressure ulcers in my current practice. I treat them in the acute hospital inpatient setting, the rehab setting, the skilled nursing facility setting and in the outpatient clinic setting.
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