IDPH cited and fined MIller Health Center in Kankakee after a resident sustained burns from a hot pack that required debridement.
The resident at issue was 82 years old and was suffering from neck pain. The nurse practitioner for his primary care physician issued an order for use of icy hot cream and a hot pack 3 times a day. The purpose of this was to loosen the muscles and provide him with pain relief. There were no instructions about how hot the hot pack should be or how long it should be applied. The nurse practitioner told the state surveyor that she assumed that there was a facility protocol that would be followed.
Unfortunately for this resident, that assumption was wrong. There were no policies, procedures, or protocols for this. The aide who was assigned to give the resident the hot packs warmed a wet washcloth up in the microwave, placed it in a plastic bag and then placed it in a pillow case. She did not know how hot it was, did not know how long it was applied to the resident’s skin, or who removed it. The resident told the surveyor that he fell asleep with it on and woke up with the burn from the hot pack. When the resident awoke he had a 6 cm x 3.5 cm burn where the pack had been applied. Ultimately, this wound required debridement.
This particular resident suffered from diabetes which tends to impair circulation. Further, at 82 years of age, this resident’s skin was thin and fragile. It is one of the reasons that bed sores are a serious issue in nursing homes. And the nursing home left it to the discretion of the aide – the least medically trained person providing care to residents – to decide whether the hot pack was too hot or cold, how it was prepared, and how long it would be applied. That is a formula for disaster. When medical care has the potential for injury to residents, the staff must be guided through training, policies, and procedures as to what must be done. The nursing home here failed to do that.
This is not to completely excuse the nurse practitioner. She provided no guidance about how the care she ordered was to be delivered and assumed that there were standard procedures at the nursing home when there were none. In practice, it h as been surprising to hear how often from doctors who have large nursing home practices have no real idea about how the care is actually delivered in the nursing and how much they defer to the nursing home staff.
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