Eldorado Rehab and Healthcare in Eldorado was cited and fined by IDPH after a resident developed an infection due to improper treatment of a skin tear.
The initial injury occurred when the when the legs to the resident’s wheelchair were being moved. It was a significant skin tear measuring 12 cm, or just under 5 inches in length. The nurses on duty closed the skin tear with steri-strips. The nursing progress note entered that day described how the skin tear occurred and reflected that the doctor entered orders for treatment. However, that order was never entered into the Physician’s Order Sheet, and the resident’s attending physician and the facility’s wound care doctor both denied having been advised that the resident suffered a skin tear.
One of the reasons that skin tears are concerning is that any breach in the skin opens up the body to infecting organisms – that is one of the reasons that bed sores are such an issue of concern in the long term care industry. And indeed, this is just what happened to this resident. She developed a cellulitis infection which led to am 8-day hospital admission.
There are three real problems with the care that was provided to this resident:
First, when a resident suffers a skin tear, it is an event which requires the nurse to notify the physician. The doctor should be the one to make the determination about what should happen after a skin tear occurs. A skin tear of this size really required a trip to the emergency room to have the wound closed more effectively than trying to pull it back together withe steri-strips. The doctor denies that this occurred, which raises the next issue.
Second, the progress note indicates that the doctor issued an order. The doctor denies that this occurred, which would be an example of false charting. One of the items that supports the doctor’s account of this is that there was no entry on the physician order sheet. Many times nurses will call the doctor and get an order over the phone, in which case there still needs to be an entry on the resident’s chart for the order which the doctor will sign off on the next time he/she is in the nursing home.
Third, one of the things that nurses should be doing when a resident has a wound, whether it is a skin tear or a pressure ulcer, is checking it for sign and symptoms of infection. By the time that this resident was brought to the hospital, there were obvious signs of infection which should have been recognized much earlier.
One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary injuries and illnesses and wrongful deaths of 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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