IDPH has cited and fined Regency of Sterling nursing home after a resident underwent surgery for a infected skin tear which had not been treated while at the nursing home.
One basic fact of life is that as we age, our skin gets thinner and more susceptible to injury. This is why bed sore prevention is a focus of care in nursing homes. With senior citizens, one form of injury to the skin that they are susceptible to skin tears. A skin tear is a traumatic injury to the skin which results in the separation of the skin, frequently with peeling back of the skin.
Most often skin tears can be treated relatively easily by bringing the edges of the skin together and using steri-strips and dressings to promote healing of the wound. However, as with any wound, the occurrence of a skin tear is something that requires physician notification and ongoing monitoring for healing and signs and symptoms of infection is absolutely required. Intact skin is the most effective barrier to having infecting organisms enter the body, and having a skin tear is a breach of the integrity of the skin.
The resident at issue sustained a skin tear to her left lower outer leg while being assisted into bed by staff. The resident had been recognized as being at risk for skin tears, and care should have been taken by the staff to avoid injury to the skin in transferring the resident to bed.
Once a skin tear occurs, the staff is then required to care for it properly and monitor for signs and symptoms of infection. This nursing home had specific policies and procedures in place which were intended to set forth what should be done in the event of a skin tear. These required notification of the physician after a skin tear occurs to obtain treatment orders, following the wound orders, and ongoing monitoring by the wound care nurse. In practice the wound care nurse would do rounds on patients with wounds weekly and she would be notified by the nursing staff that there was a new patient with a wound that required care.
The first problem that occurred here is that the first step – notifying the physician and obtaining treatment orders never happened. There was no record in the chart of the physician being notified. There were no orders from the doctor recorded in the resident chart. The resident was not added to the roster of patients who required care from the wound care nurse. The Treatment Administration Record did not show that there was monitoring of the wound or care being provided. The basic steps to initiate care were simply not taken.
The facility policies called for an incident report to be completed – and it appears from the text of the citation that an incident report was in fact completed. However, in a well-run facility, incident reports are more than paperwork which is finished. They should be a catalyst for the administration to investigate and make sure that proper follow-up was being done. The records of this resident seem to indicate that was not the case here.
The failures of the nursing home in this case do not end there, however. Even with a wound care nurse on staff, this does not absolve the nurses and staff on the floor of their responsibility to serve as the “eyes and ears” of the doctors and to notify the doctor when a resident is demonstrating signs and symptoms of an infection. Nurses do not need to know how to treat an infection, but they do have to be able to recognize the signs and symptoms, which can include: fever, redness and warmth of the affected area, blistering of the skin, drainage, and changes in mental status, among other signs.
Five days after the resident sustained the skin tear, the resident demonstrated increased confusion. After the nurse on the floor did an assessment, she paged the on-call nurse practitioner who ordered the nurse to call 911 and have the resident sent to the emergency room.
Once the resident was brought to the emergency room, her temperature measured 102.6 degrees. Her leg showed large fluid filled blisters from her ankle up to mid calf with tenderness and red and blue discoloration. The infectious disease physician diagnosed her as suffering from necrotizing fasciitiis, or flesh-eating disease. He recommended antibiotics and immediate surgical debridement.
There were a number of issues with the care that this resident received:
- Depending on the facts and circumstances, the skin tear itself could be evidence of improper technique or potential understaffing of the nursing home;
- There was no notification to the doctor or even the wound care nurse, which resulted in inadequate treatment and monitoring of the wound;
- There was no follow-up to the incident report which was generated concerning the incidence of the skin tear;
- There was inadequate care by the staff on the floor after the skin tear occurred, as there were likely signs and symptoms of the infection days before the nurse practitioner was notified;
- There were multiple violations of facility policies and procedures.
All of these failures together led to the resident experiencing a devastating infection which will require significant medical care, all of which could and likely would have been avoided with routine follow-up care to the kind of injury that happens fairly frequently in a nursing home setting. Simple steps not taken led to disaster.
One of our basic 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.
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