IDPH has cited and fined Helia Healthcare of Belleville after a resident there suffered complications from an untreated infection at the surgical site for a pacemaker.
The resident at issue was admitted to nursing home after having surgery to have a pacemaker installed. When surgery is done to install a pacemaker, there is a surgical wound where the pocket for the pacemaker is located. Like any surgical wound, it requires regular skin checks for signs of infection. One of the basic skills of a nurse working in a long term care setting is being able to identify signs and symptoms of infection – and in the case of surgical wounds, cellulitis is one of the principal forms of infection to be concerned about. When signs of infection are present, it is the responsibility of the nurse to notify the doctor so that the doctor can either issues order for treatment over the phone, come into the nursing home himself, or have the patient transferred to the hospital.
In this case, the patient was brought into the doctor’s office for a post-op check about 5 months after the surgery was done. When the nurse practitioner saw the condition of the wound, she had the resident sent to the emergency room immediately. In the emergency room, the doctor saw an open wound with erythema, swelling, and very tender to touch. Wound cultures were taken which showed multiple multiple drug-resistant organisms in the wound. The resident was admitted to the hospital to have the pacemaker removed and a new one placed.
When the state surveyor asked the nurse practitioner how long the pacemaker wound was in that condition, she estimated 2-4 weeks before the patient came into the office. The surveyor then checked with multiple staff members all of whom had some responsibility for checking the condition of the resident’s skin. All of them denied noticing anything abnormal about the resident’s skin. The normal course of a cellulitis infection is that it starts off as a fairly mild redness around the edges of the wound which can treated fairly easily. Serious problems result though when the infection is left untreated which was apparently the case here given the severity of the infection and the appearance of the surgical wound. This means one of two thins is true: either the staff did not know what they were looking for (which is really a basic nursing skill), the checks were not being done (most likely), or that the abnormal findings were just not being reported to the doctor. None of these scenarios represent acceptable nursing care.
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