The Presence Villa Franciscan nursing home in Joliet was cited and fined by the Illinois Department of Public Health after a resident admitted for rehab following a revascularization surgery developed a significant infection at the surgical site.
The resident at issue had been admitted to the nursing home after undergoing a femoral-popliteal bypass surgery. There was a 7 cm incision at the surgical site which had been closed with 27 staples. The discharge orders included instructions to notify the surgeon if there was redness, swelling, drainage, or foul smell from the incision site and to paint the incision twice per day with Betadine and to cover with a dressing. Betadine is used to treat minor skin infections.
One of the basic jobs of a nurse is to notify the resident’s doctor when signs or symptoms of a cellulitis infection are present, and the things listed: redness, swelling, drainage, and foul odor are classic signs of an infection.
The resident returned to see the doctor 10 days after being admitted to the nursing home. During that time in between, there was only one nurse’s note which indicated that the nurses inspected the surgical incision and that one reflected that the Betadine had not been used because its telltale staining was not present. When the doctor saw the wound he quickly determined that there was an extensive infection that had been present for some time because the staples from the wound were coming out. He brought the resident back in for an extensive surgery to remove the infection. A wound vac was required to help close the wound.
One of the basic functions of the nursing staff is to monitor for signs and symptoms of infection. It is not up to them to diagnose and actual infection, determine what kind of infection is present, or how to treat the infection. That is the role of the doctor, but the doctor cannot do that when the nursing staff fails to notify him that there may be an infection present.
When I take depositions of nurses I ask if they agree that the doctors are not there on a 24/7 basis and it is the job of the nursing staff to act as eyes and ears for the doctor. I get universal agreement on that concept. The nurses here failed that role and subjected this lady to a more extensive surgery and a worse surgical wound.
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