IDPH has cited and fined Timbercreek Rehab nursing home in Pekin after a resident’s bed sore declined to the point that surgery was required.
“Bed sores” are sometimes referred to as “pressure ulcers” because one of the main components in causing these painful wounds is pressure from the resident’s own body weight over the bony prominences, such as the hips, heels, and tailbone. This is why these are the most common places for nursing home residents to develop bed sores. In essence, what happens is that due to muscular weakness, residents in nursing homes do not move as frequently, and the resident’s body weight squeezes the tiny blood vessels that supply the skin, causing injury and death to the skin. This results in the wound that is commonly known as a “bed sore.”
Because pressure from the bony prominences is a well-known risk factor for developing bed sores, one of the main tactics used to limit the development of bed sores and promote the healing of bed sores once they occur is frequent turning and repositioning. Typically, this is done every two hours, but with certain residents, this is done every hour. Repositioning the resident relieves the pressure and helps prevent injury to the resident. Failing to do that is something which causes bed sores to develop and worsen once they occur. The difficulty with this is that this is something that needs to be done consistently, day-to-day, shift-to-shift. Failing to do so one time will usually not cause a bed sores, but the cumulative effect of not doing so multiple times usually will. Failing to provide this kind of care after a bed sore develops will almost certainly keep from healing and leads to further decline of the wound.
On February 12, the resident at issue had an area of skin that was excoriated (meaning it was red, raw, irritated) but was almost resolved. The resident’s pressure ulcer care plan called for him to be turned and repositioned every 2 hours. On February 21, the resident had an area of skin that was described as a pressure wound measuring 1 cm x 0.7 cm x 0.1 cm. This corresponds roughly to a Stage 2 pressure ulcer. The resident was sent to the hospital for an unrelated issue and the staff there measured the wound as being 2.5 cm x 2.5 cm. When he was returned to the nursing home on March 14, it was described as being the same size.
The resident was returned to the hospital on April 7 due to confusion and lethargy. The wound was described as being 6 cm x 8 cm x 0.5 cm with the wound being completely necrotic, or consisting of dead tissue. The resident’s doctor determined that the wound required surgical debridement to remove the dead tissue. Post-operatively the wound was measured at 7.5 cm x 7.5 cm with 13 cm of tunneling and bone exposed. Having bone exposed increases the risk of developing an infection called osteomyelitis.
When interviewed by the state surveyor, the surgeon told the surveyor that pressure ulcer was the direct result of prolonged pressure on the one area and sitting in that one position too long. The wound care nurse told the surveyor also told the surveyor that this bed sore was preventable with timely repositioning and proper care. The resident’s son described for the surveyor visiting his parent at the nursing home and that prolonged periods of time would pass without any repositioning by the staff.
This is a classic example of how a bed sore declines and causes serious medical consequences for a nursing home resident. Turning and repositioning residents is a staple of the work that aides in nursing homes do, but the press of the many things that they have to do often keeps them from getting this crucial work done. The root cause of this is understaffing of the nursing home, which is one the ways in which the failure of the nursing home to deliver on the care that residents require is baked right into the nursing home business model.
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: