When it comes to pressure injuries, diabetic wounds, and venous wounds, investing in expertise up front can help you avoid spending time and money on legal proceedings after the fact when wounds go wrong.
The Agency for Healthcare Research and Quality calculates that more than 17,000 lawsuits related to pressure injuries are filed each year. Reviewing pressure injuries and the law in a spring 2012 article in the Journal of Legal Nurse Consulting, attorney Joshua Silverman notes that potential legal consequences include sizeable financial verdicts, civil penalties, and—in extreme cases—even criminal penalties.
Understanding the legal implications of gaps in care can help protect all involved: physicians, nurses, other caregivers, and healthcare administrators and leaders. To minimize liability, the entire healthcare team can benefit from training in the following areas:
- Recognizing wound risk factors
- Carefully assessing on admission
- Keeping accurate documentation
- Implementing evidence-based preventive measures
- Providing timely treatment of wounds
For patients, pressure injuries and other wounds can carry a long-term burden of physical and emotional suffering, but pressure injuries also carry the threat of financial harm for healthcare organizations. The average cost to treat a pressure injury ranges from $21,000 to $152,000.
Because the Centers for Medicare and Medicaid Services will not reimburse healthcare organizations for costs associated with hospital- or facility-acquired pressure injuries, appropriate assessment at the time of admission is vital. Risk assessment tools are one piece of the puzzle.
The average cost to treat a pressure injury ranges from $21,000 to $152,000.
Along with a thorough assessment, complete documentation of clinical findings at the start is vital to protecting your facility against liability down the road. If pieces are missing, your legal foundation could crumble.
Aware and Alert
Wound care training for nurses and other staff can promote a culture attuned to the risks and best treatment protocols. Pressure injury prevention programs can minimize the risk of lawsuits spurred by patients acquiring these wounds in a skilled nursing facility. In addition to hefty financial judgments against the organization, the potential repercussions of lawsuits include damage to a provider’s professional reputation and career options.
To avoid these types of lawsuits, your facility needs a team of nurses and other caregivers who are competent in assessing pressure injury risks and documenting findings, confident in following the latest and greatest standard of care, and able to communicate the treatment approach to the patient and family members.
Factors spurring legal action often involve behavioral as well as clinical skills. Many healthcare lawsuits are filed because patients or their families note a lack of caring attitude among providers, notes Nancy Collins, a registered dietitian with medico-legal expertise. Families who take legal action often complain of incompetent, inattentive, or uncaring treatment, she says in a blog post on healthcare expectations.
Although healthcare providers use the term “pressure injury,” family members often still use the term “bedsore.” That word carries implications of neglect and can inspire guilt in family members who feel the wound should have been preventable. “Chronic and nonhealing wounds are perhaps one of the most emotional issues,” Collins says, “and the number of lawsuits because of wounds is staggering, in part because of this emotion.”
A legal review of a pressure injury case considers whether the injury was avoidable or unavoidable. Documentation in the patient’s electronic health record (EHR) is an important part of this determination. For patients with known risk factors, the EHR should clearly show what steps were taken to prevent a pressure injury from occurring.
The importance of keeping accurate and complete notes is worth repeating. As Collins advises in another blog post on accurate wound care documentation, clinicians should avoid these mistakes:
- Calling all skin integrity problems pressure injuries.
- Using the words “sacrum,” “coccyx,” and “buttocks” interchangeably.
- Not correctly identifying or describing wounds present on admission.
- Confusing “left” and “right”; notes should identify patient’s left or right side.
- Lacking a consistent system for documenting routine care, such as repositioning.
- Improperly or inconsistently measuring and recording wound size.
- Recording the person’s stated weight as actual body weight.
- Failing to act on assessments that indicate a patient is at risk.
- Not communicating wound status to the responsible family member.
Careful note taking is equally important when it comes to professional consultations. If a facility has a wound care specialist on staff designated to consult with clinicians, the specialist will need to set clear expectations for when and how those consultations happen.
Allowing clinicians to have a rushed hallway consultation is risky, notes healthcare attorney Nancy J. Brent in her blog post. Instead, wound care specialists should make sure that consultations involve a careful review of the clinical problem and that they take notes during the consultation.
After a consultation, Brent advises, the specialist should check back in to determine if the care team followed the recommendations, if the patient improved, and if new treatment is needed. The EHR should accurately reflect the consultation and treatment guidance and the steps taken to prevent or treat the wound. Ensuring that consultations are handled in a professional way will protect all involved in the treatment.
When a pressure injury unfortunately does develop, it could be classified as “unavoidable” if it “developed even though nurses implemented interventions consistent with patient’s needs and standards of practice,” according to a wound care primer by Ann M. Peterson in the spring 2012 issue of the Journal of Legal Nurse Consulting. Peterson also notes that a legal nurse consultant reviewing a pressure injury case would seek evidence that interventions were put in place to prevent skin breakdown.
Although acute care hospitals report using various strategies to prevent pressure injuries, those efforts are not always systematically applied to bring consistent results, according to a recent study of Veterans hospitals. Even when hospitals implemented multipronged prevention strategies—such as policies, education, use of wound care specialists, and review of performance data—researchers L. M. Soban and colleagues found notable variation in how the strategies were operationalized.
In terms of future action, the researchers noted that nurse leaders should look for opportunities to influence the implementation of prevention programs. Depending on the particular organization, that might mean arranging for specialized wound care training or analyzing the data to find ways to reduce variations in care.
Whether your organization provides acute or long-term care, keeping patients and residents from developing pressure injuries is the ideal situation. Once a patient has a pressure injury, the risks mount, including the following potential complications:
Those types of complications from hospital-acquired pressure injuries are linked to almost 60,000 U.S. hospital patient deaths each year, according to the National Pressure Ulcer Advisory Panel.
In a study of Medicare Patient Safety Monitoring System data, researchers C. H. Lyder and colleagues found that patients with hospital-acquired pressure injuries “were more likely to die during the hospital stay, have generally longer hospital lengths of stay, and be readmitted within 30 days after discharge.”
Considering the increased mortality rate and the threat of legal action, the consequences of inadequate wound care are unwelcome, to say the least.
As a leader, consider wound care education an investment in your team and in the entire organization’s reputation. Doesn’t it make sense to have clinicians learn their lessons from wound care experts instead of legal proceedings?
When you invest in staff education and analyze variations in care, you are taking evidence-based steps to reduce patient morbidity and mortality while limiting fiscal and legal threats to your organization.
With proactive steps, you can use your leadership power to heal the gaps in wound care education.