Tuesday, August 11, 2009

Nursing Home Negligence Cases

One of the most common nursing negligence issues we are called upon to illustrate is the development or progression of pressure sores (sometimes know as bed sores or decubitus ulcers). Pressure sores are areas of injured skin and tissue usually caused by sitting or lying in one position for too long. This often happens if you use a wheelchair or you are bedridden, even for a short period of time (for example, after surgery or an injury). When a change in position doesn't occur often enough and the blood supply gets too low, a sore may form. The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.

A pressure sore starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure sores are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head. Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst):

• Stage I: A reddened area on the skin that, when pressed, is "non-blanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop.
• Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
• Stage III: The skin breakdown now looks like a crater where there is damage to the tissue below the skin.
• Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.

In most cases pressure sores are preventable and, if not prevented, should be recognized early and appropriately treated. In almost all situations, the development of massive pressure sores is evidence of some form of deviation in the standard of nursing care (neglect). Generally the neglect is in more than one area, i.e., hygiene, nutrition, infection control, protection and positioning.

The common areas for the formation of pressure sores and their prevention is a basic area covered in all nursing schools by all licensed nursing programs (LVN or RN). Prevention consists of changing the person's position every two hours or more often if needed. The two-hour time frame is a generally accepted maximum interval that tissue can tolerate pressure without damage. Prevention also consists of protection and padding to prevent tissue abrasion as well as the elements of nutrition, hydration, hygiene, etc. Turning and positioning is common knowledge for physicians, licensed nurses (LVN or RN), and physical therapists as well as paraprofessional care gives (nursing assistants). Turning is applicable even on flotation mattress beds.

Treatment for pressure sores involves removing all pressure from the involved area(s) to prevent further decay of tissue and promote healing. Frequent turning is mandatory to alleviate pressure on the wound and to promote healing. Treatment also involves keeping the area clean, promoting tissue regeneration and removing necrotic (dead) tissue, which can form a breeding ground for infection. There are many procedures and products available for wound care, cleaning and pressure reduction. The use of antibiotics when appropriate is also part of the treatment. Some deep wounds even require surgical removal or debridement of dead tissue. Without all of these elements being in place, the wounds will not heal and, in fact, will quickly worsen.

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