Nursing homes must deal with residents who either have or acquire bed sores. Some of those wounds exist when the resident comes in the door from the community or as a transfer patient from a hospital or another nursing home. Whether the bed sores are acquired at the nursing home or elsewhere, the nursing home’s responsibility is the same: to make sure that the resident gets proper care.
While much focus is given to “new” bed sores, nursing homes also have special obligations under federal regulations regarding bed sores once they have occurred. Specifically, 42 CFR, Part 483.25(b)(1)(ii) provides that residents with pressure ulcers receive care and treatment consistent with standards of professional practice, to promote healing, prevent infection, and prevent new ulcers from developing.
When a resident enters a nursing home, one of the first things that is done is a head-to-toe skin assessment. The nursing home wants to be sure to note any skin breakdowns that existed as soon as the resident came in the door – partially so that treatment can be initiated and partially so that the nursing home can point fingers elsewhere should things go badly later during the resident’s admission.
If the resident, does not have any bed sores, then an assessment is done, typically using the Braden Scale as part of the care planning process.
If a resident has a bed sore, there are a number of steps that must be taken:
The nurse must notify the resident’s doctor – When a resident enters a nursing home from a hospital already suffering from a bed sore, there will typically be orders with the transfer. Nonetheless, the resident’s doctor needs to confirm those orders. If the resident develops a new bed sore while at the nursing home, then this is a change in condition which requires physician notification so that the doctor can provide the nursing staff with orders for care.
Care planning must be done to treat the bed sore – If the resident is a new admission to the nursing home, this must be done as a matter of course. For residents who develop a bed sore during their admission, this represents a significant change in condition which requires a change to the care plan.
Provide care and treatment for the wound – Once a bed sore is present, then the nursing staff is obligated to care for it, consistent with the doctor’s orders, the resident’s care plan, and facility policies and procedures. This care should be documented on the resident chart so that the nursing staff and other health care professionals such as a wound care nurse can track the effectiveness of the treatments.
Adjust the resident’s nutritional care – One factor that affects a resident’s ability to recover from a bed sore is their nutritional health, especially their caloric intake and protein levels. A consultant nutritionist will often be asked to evaluate a resident and make recommendations of nutritional steps that can be taken to promote healing of the wound.
Monitor the condition of the wound – The nursing home staff has an ongoing responsibility to check the condition of the wound, checking for declines or worsening of the wound or for the onset of infections such as cellulitis or osteomyelitis.
How can treatment of a bed sore be the basis for a nursing home lawsuit?
There are a number of theories we look at when considering wound care as a basis for a nursing home abuse and neglect lawsuit:
Failure to provide treatments as ordered – Bed sores do heal quickly. Once they become significant (Stage 3, Stage 4, or unstageable bed sores), getting them to heal is a task which often takes several weeks. If the care which is required is not provided over that time frame, recovery from the bed sore is unlikely, and having the bed sore become something which serves as a basis for a nursing home wrongful death lawsuit is ever more likely.
Failing to keep dressings and skin clean – Many residents with bed sores are bed or chair-bound and suffer from incontinence – it is part of why they got bed sores to begin with. When the dressing are soiled with urine and feces, not only do the wounds suffer the negative effects from the moisture and chemicals in the bodily waste, the broken skin is exposed to the bacteria in the urine or feces which can lead to serious infections.
Failure to monitor the condition of the wound – There are two main aspects to this: (1) checking the wound to see if it is getting worse and (2) monitoring for signs of infection. Nurses are not required to be able to diagnose an infection or know what drugs to use to treat an infection, but they are required to know the signs and symptoms of an infection and to notify the doctor about their onset.
There are many cases where residents suffer horrific outcomes because of bed sores and the fault of the nursing home staff lies largely with how the bed sores were treated (or not) once they developed. Being able to view a case in this way requires the help of an experienced Chicago nursing home lawyer. Contact our office today for a free, no-obligation review of your case and to learn what your rights are after you have a parent or loved one suffer due to bed sores in a nursing home.