IDPH has cited and fined Hilltop Skilled Nursing and Rehabilitation in Charleston after the staff there failed to follow physician’s orders, resulting in a resident developing a Stage 4 bed sore on her heel.
While we often discuss in this blog how important care plans are in delivering the routine care that nursing home residents need, following physician orders is also something that is mandatory. Failing to follow physician orders can be just as devastating.
The resident at issue developed a bed sore to her left heel. A wound care physician was brought into manage her care. He issued orders for the care of the wound, including use of heel protectors due to her immobility. A heel protector is something that is used to reduce the incidence of bed sores on the heels and to promote healing of any bed sores already present by reducing pressure on the skin between the bed and bony portion of the heel and by eliminating the exposure to shear.
The care provided by the doctor was effective in healing the bed sores, and when the wound care doctor discharged the patient, he included an order to continue present skin care and breakdown prevention. This would have included the use of heel protectors because they are used as tools for both healing and prevention of bed sores. There was never any documentation of the use of heel protectors, and the Director of Nursing admitted to the state surveyor that the heel protectors which had been ordered were not used after the wound on the heel closed.
Approximately 2 weeks later, the resident was diagnosed as having an unstageable wound to the left heel. The wound care physician did a bedside surgical debridement and determined that after all the dead tissue was removed, that it was a Stage 3 bed sore. Unfortunately, the wound continued to decline, requiring an additional bedside surgical debridement. After that was completed, the resident was left with a Stage 4 bed sore on the heel – exposed muscle and/or bone. Having a bed sore of this severity is significant for nursing home residents because it leaves the resident at greatly increased risk for an infection like osteomyelitis.
The resident’s attending doctor attributed the development of the bed sore to the failure of the staff to use the heel protectors as ordered. Nursing homes often defend bed sore cases by claiming that the bed sores were unavoidable due to the chronic medical conditions of the resident but the statement from the physician. The fact that this resident had sores which healed is also significant because it tends to show that there were no real biological impediments to healing which undermines the idea that the chronic medical conditions doomed this resident to suffering bed sores.
One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result. Order our FREE report, Built to Fail, to learn more about why. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.
Other blog posts of interest: