IDPH has cited and fined Moweaqua Rehab nursing home after a resident there suffered declines in bed sores on his heel and on his coccyx.
Bed sores, or pressure ulcers, are a major issue in the long-term care industry. There are two basic federal regulations pertaining specifically to the topic of bed sores. The first essentially provides that when a resident enters a nursing home without a bed sores, the nursing home should provide care to the resident such that the resident does not develop them unless they are unavoidable. The second addresses what happens once a resident has a bed sore, and this provides in essence that a resident who has a bed sore should receive care, treatment, and services necessary to promote healing, prevent infection, and prevent the development of new bed sores.
Bed sores are a specific issue issue that is addressed during the care planning process. A resident’s risk of developing bed sores is assessed, typically using a standardized tool such as the Braden scale. A care plan is then put into place which addresses the various risk factors that are present for the resident.
The primary risk factors are immobility, incontinence, and poor nutritional status. Immobility is customarily addressed by a turning and repositioning schedule which provides for offloading of the body and through the use of pressure-reliving devices. Incontinence is addressed by ensuring timely care after episodes of incontinence and through the use of barrier creams. Poor nutritional status is addressed by adding additional servings of protein with meals or providing nutritional supplements.
When the resident at issue was admitted to the facility, he was assessed as being at high risk for bed sores. He in fact entered into the nursing home with a bed sore – a Stage 3 wound to his sacrum. The resident chart documented that care was being provided as ordered, but the only assessments of the wound were being done on the Weekly Wound sheets. Approximately two and half months after admission, the resident was brought to the local wound clinic where he the wound was shown to be nearly double in size and considerably deeper, with exposed muscle and eschar in the wound bed. The wound clinic order the use of a wound vac, and also issued orders for the use of pressure relieving devices, including a specialized mattress and special wheelchair cushion, and for turning and repositioning. However, those orders were never incorporated into the resident’s care plan or if they were ever carried out. The resident’s record documented that wound vac was used after it was ordered, but there was no record as to how much fluid was being removed from wound by the wound vac. Eventually, the resident was brought to the hospital to undergo surgical debridement of the bed sore.
At the same time that the resident was receiving the orders for the wound vac for his sacral bed sore, he also developed a Stage 2 bed sore on his heel. There was an order for the use of heel boots, but wound continued to decline and by the time that the resident was undergoing surgery for the sacral bed sores, the one one the heel had declined to the point that it was unstageable. Unstageable bed sores are by definition at least Stage 3, but could be Stage 4 bed sore, but the presence of dead tissue in the wound bed obscures the bottom of the wound bed keeps the wound from being staged definitively as Stage 3 or Stage 4.
When the state investigator interviewed staff from the wound clinic, they were clear in their opinions: that the nursing had failed to follow the instructions that they gave, and that this led to the deterioration of the sacral wound and the development and decline of the wound on the heel.
Bed sores present a difficult issue for nursing homes in that the residents who develop them often have pre-existing conditions which leave them susceptible to developing them. This basic fact is actually built into the Braden Scale. Because the medical issues that leave residents are persistent, the care that the residents require truly has to be provided on a 24/7 basis on a day-to-day, shift-to-shift basis. The fact that this resident saw significant declines in wounds on two areas of his body says that this care simply was not being provided as needed.
When the kind of routine care that is needed to give residents a fighting chance against bed sores is not being offered, that is a sign of an understaffed nursing home, and having an understaffed nursing home is one of the hallmarks of 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.
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