IDPH has cited and fined Nokomis Rehabilitation & Health Care Center in Nokomis after a resident was discovered to have an unstageable pressure ulcer.
Bed sores are a major issue in the long term care industry. This is an area which is specifically addressed in federal regulations. Nursing homes are charged with responsibility for preventing bed sores in residents who enter the nursing home without any and with providing necessary care, treatment, and services to promote healing and prevent infection and the development of new bed sores in residents who have them.
Bed sores are a specific area of resident assessment when a resident is admitted to the nursing home, usually using the Braden scale. Many residents have specific care plans to address prevention of bed sores. When a resident is at risk for a bed sore, regular skin checks are part of the routine. Development of a bed sore is a significant change in condition which requires the nurse to notify the doctor to obtain treatment orders and requires revision of the care plan.
When the resident at issue was admitted to the nursing home in July, 2018, he was scored at a 19 on the Braden scale, which corresponds to a moderate risk of devloping bed sores. The nursing home’s policies and procedures called for daily skin checks. When the bed sore on his buttocks was first documented in late October, it was 4×7 cm with a 2×2 cm necrotic area.
This is considered an unstageable pressure ulcer because the area of necrotic tissue concealed the base of the wound, so its true depth could not be determined. By definition, an unstageable pressure ulcer is at least a Stage 3 or Stage 4 bed sore. Necrotic tissue is dead tissue which suggests that the bed sore had been present for some time before and should have been seen earlier. This was the conclusion of the doctor and the director of nursing.
When we look at cases involving bed sores, it is always important to look at both aspects of the care that the resident received. One part looks at what was done to prevent the development of the bed sore to begin with, but the more often overlooked aspect of the case is what was done after the resident developed the bed sore. Many times, we find that when a resident leaves a facility to go to another nursing home or to the hospital, the staff at the next place is documenting a sore that is in far worse condition than the records from the nursing home reflect.
Bed sores which are not reported and treated in a timely way are often set up for the inset of infection like cellulitis or osteomyelitis and these can in turn lead to sepsis are ultimately result in the wrongful death of the nurisng home resident.
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