Video Treating Pressure Ulcer

Providing Wound Care And Treating Pressure Ulcer Ppt Presentation

Nursing home safety: Troubled Chicago nursing home may lose funding

Nursing home news: Federal authorities are moving this week to terminate Medicaid funding to the troubled Wincrest Nursing Center on the city's North Side after state and federal inspections documented nursing home residents engaged in bloody fights and drug abuse that spilled from the facility out into the surrounding community. An 80-bed home that primarily houses adults with mental illnesses, including dozens with felony records, Wincrest has for years been the subject of complaints by local officials and neighbors, as well as students and staff from nearby Loyola University Chicago. Seven Loyola residence halls housing about 600 students stand within a block of the home at 6326 N. Winthrop Ave. Authorities have documented knife attacks, drug abuse at Wincrest Nursing Center. We earlier pointed out the problems facing residents when past felons are admitted into nursing homes and discussed the danger to elders when this happens.
See blog post http://malpractice.blogspot.com/2011/11/admitting-past-felons-into-nursing.html
See Release: http://www.lawfirmnewswire.com/2011/11/massachusetts-elder-abuse-lawyer-warns-of-danger-of-admitting-past-felons-to-nursing-homes/
Nursing home safety: Troubled Chicago nursing home may lose Medicaid funding - chicagotribune.com

Nursing home workers arrested for 'waterboarding' a dementia care resident

Two nursing home workers in Georgia were arrested after a coworker reported them to the police for performing a waterboarding-like attack against a resident with severe dementia.
A grand jury indicted the two women, on charges of false imprisonment and battering a nursing home patient, for the 2008 incident, The Huffington Post reported. According to a local report, the workers confined the 89-year-old nursing home resident to a shower room, and held back her arms and wrists while using a shower nozzle to simulate the sensation of drowning. The alleged attack was reportedly sparked by an argument about ice cream. The employees are both awaiting a trial date.
Intentional assaults, such as the type involving Kindred CNA Bernadette Stackpole can and should be criminally prosecuted. In most states not assaults on nursing home residents is a crime.
Nursing home workers arrested for 'waterboarding' a dementia care resident - McKnight's Long Term Care News

Were Nursing Home Regulations too Burdensome for Lifecare?

In a recent sucessful litigation against Lifecare Nursing Home of Lynn Massachusetts, Lifecare's attorneys filed several motions to exclude evidence or to get advance rulings on the use of arguements they did not want made at trial. The case alleged nursing home negligence involving the wrongful death of a disabled resident.
On such motion "in limine"by Lifecare sought to prevent Plaintiff from arguing that the various state and federal regulations regulating nursing homes constituted the "standard of care" applicable to nursing home care. Actually I never intended to argue that the regulations were the per se standard of care.  In fact the Judge denied their pre trial motion. I was allowed to argue that the regulations were relevant for consideration.

What was eye opening was the language Lifecare put forth in support of their motion:

"When a practical nursing home is compared to these standards, it would be virtually impossible for the nursing home to avoid a finding of negligence."

The Hamill Firm of Quincy, Massachusetts concentrates their practice on advocating for elderly nursing home residents and has a successful track record of verdicts and settlements including some of the highest emotional distress verdicts ever awarded in Massachusetts for nursing home abuse. The Hamill group encourages all residents injured by neglect in Massachusetts nursing homes to call for a free evaluation of their claim. 

Flexible Nutrition Aproach recommended for Nursing Home Residents

When planning nursing home residents' meals and dining experiences, Food has to look good, taste good, and be offered courteously and in a comfortable setting... Long-term care facility providers should avoid overcomplicating the operation of food services and follow common sense principles. Multiple factors can complicate fulfillment of nursing home residents' nutritional needs. Altered metabolism, medication, or illness can bring on loss of appetite; shortage of staff to assist dependent residents at mealtimes are also obstacles facing long-term care facilities.
Strategies for enhancing the nutritional status of residents, include:
- Careful assessment of altered nutritional status;
- Flexibility in accommodating residents' food and eating preferences;
- training of staff;
- Improved staff communication

Residents families should always be polled as to their loved ones eating preferences and habits. Following these rules can avoid malnutrition, dehydration and rapid weight loss.

Massachusetts Regulations 105 CMR 150 .. state:
(G) Preparation and Serving of Food
(1) All foods shall be prepared by methods that conserve the nutritive value, flavor and appearance.

Federal Regulations 42CFR 483.35 "Dietary Services" states that:
(d) Food. Each resident receives and the facility provides--

(1) Food prepared by methods that conserve nutritive value, flavor, and appearance;
(2) Food that is palatable, attractive, and at the proper temperature;

Significant weight loss can often be avoided. If not stemmed however it can lead to a downward spiral of a residents health. Adherence to the existing regulations added to a specifically tailored diet for the resident can go a long way toward health maintenance.

The Hamill Firm of Quincy, Massachusetts concentrates their practice on advocating for elderly nursing home residents and has a successful track record of verdicts and settlements including some of the highest emotional distress verdicts  ever awarded in Massachusetts for nursing home abuse. The Hamill group encourages all residents injured by neglect in Massachusetts nursing homes to call for a free evaluation of their claim. 

AMDA

Massachusetts Finishes in Bottom Third of States for Nursing Home Care

"Lowered Expectations" in Massachusetts Nursing Homes

Massachusetts Long Term care report cards including Nursing Home care marks graded Massachusetts at the third out of fourth quadrants for nursing care quality.
For these importatnt indicators see the state rank (out of 50)
- Quality of Life & Quality of Care: 34th
- Support for Family Caregivers: 39th
- Percent of home health episodes of care in which interventions
to prevent pressure sores were included in care plan for at-risk patients: 40th
- Percent of adults age 18 with disabilities living in the community
who are satisfied or very satisfied with life: 38th
- Percent of home health patients with hospital admission: 38th

- Cost: 17th most expensive

The disparity between the quality of services delivered and the cost of nursing home care is telling and unacceptible in a state with so many top level health care resources. In this case "you don't get what you pay for".
Massachusetts State Scorecard - The Commonwealth Fund

Quality of Care Ftag 309 Nursing Home Regulations

§483.25 Quality of Care (Ftag 309) regulating Nursing Home care:

States that “Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.”

The stated Intent of section: §483.25  is that the “facility must ensure that the resident obtains optimal improvement or does not deteriorate within the limits of a resident’s right to refuse treatment, and within the limits of recognized pathology and the normal aging process.”

Definitions: §483.25

“Highest practicable physical, mental, and psychosocial well-being” is defined as the highest possible level of functioning and well-being, limited by the individual’s recognized pathology and normal aging process. Highest practicable is determined through the comprehensive resident assessment and by recognizing and competently and thoroughly addressing the physical, mental or psychosocial needs of the individual.

Interpretive Guidelines §483.25 - Unavoidable harms to nursing home elders:

In any instance in which there has been a lack of improvement or a decline, one must determine if the occurrence was “unavoidable or avoidable”. A determination of unavoidable decline or failure to reach highest practicable well-being may be made only if all of the following are present:

• An accurate and complete assessment (see §483.20);

• A care plan that is implemented consistently and based on information from the assessment; and

• Evaluation of the results of the interventions and revising the interventions as necessary.

Compliance with F309, Quality of Care - The nursing home facility is in compliance with this requirement if staff:

• Recognized and assessed factors placing the resident at risk for specific conditions, causes, and/or problems;

• Defined and implemented interventions in accordance with resident needs, goals, and recognized standards of practice;

• Monitored and evaluated the resident’s response to preventive efforts and treatment; and

• Revised the approaches as appropriate.

Full Text of

42CFR483.25 Quality of care

    Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.

    (a) Activities of daily living. Based on the comprehensive assessment of a resident, the facility must ensure that—

    (1) A resident’s abilities in activities of daily living do not diminish unless circumstances of the individual’s clinical condition demonstrate that diminution was unavoidable. This includes the resident’s ability to—

    (i) Bathe, dress, and groom;

    (ii) Transfer and ambulate;

    (iii) Toilet;

    (iv) Eat; and

    (v) Use speech, language, or other functional communication systems.

    (2) A resident is given the appropriate treatment and services to

maintain or improve his or her abilities specified in paragraph (a)(1) of this section; and

    (3) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene.

    (b) Vision and hearing. To ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities, the facility must, if necessary, assist the resident—

    (1) In making appointments, and

    (2) By arranging for transportation to and from the office of a practitioner specializing in the treatment of vision or hearing impairment or the office of a professional specializing in the provision of vision or hearing assistive devices.

    © Pressure sores. Based on the comprehensive assessment of a

resident, the facility must ensure that—

    (1) A resident who enters the facility without pressure sores does

not develop pressure sores unless the individual’s clinical condition

demonstrates that they were unavoidable; and

    (2) A resident having pressure sores receives necessary treatment

and services to promote healing, prevent infection and prevent new sores

from developing.

    (d) Urinary Incontinence. Based on the resident’s comprehensive

assessment, the facility must ensure that—

    (1) A resident who enters the facility without an indwelling

catheter is not catheterized unless the resident’s clinical condition demonstrates that

catheterization was necessary; and

    (2) A resident who is incontinent of bladder receives appropriate

treatment and services to prevent urinary tract infections and to

restore as much normal bladder function as possible.

    (e) Range of motion. Based on the comprehensive assessment of a resident, the facility must ensure that—

    (1) A resident who enters the facility without a limited range of motion does not experience reduction in range of motion unless the resident’s clinical condition demonstrates that a reduction in range of motion is unavoidable; and

    (2) A resident with a limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion.

    (f) Mental and Psychosocial functioning. Based on the comprehensive assessment of a resident, the facility must ensure that—

    (1) A resident who displays mental or psychosocial adjustment difficulty, receives appropriate treatment and services to correct the assessed problem, and

    (2) A resident whose assessment did not reveal a mental or psychosocial adjustment difficulty does not display a pattern of decreased social interaction and/or increased withdrawn, angry, or depressive behaviors, unless the resident’s clinical condition demonstrates that such a pattern was unavoidable.

    (g) Naso-gastric tubes. Based on the comprehensive assessment of a resident, the facility must ensure that—

    (1) A resident who has been able to eat enough alone or with  assistance is not fed by naso-gastric tube unless the resident’s clinical condition demonstrates that use of a naso-gastric tube was unavoidable; and

    (2) A resident who is fed by a naso-gastric or gastrostomy tube  receives the appropriate treatment and services to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and  nasal-pharyngeal ulcers and to restore, if possible, normal eating skills.

    (h) Accidents. The facility must ensure that—

    (1) The resident environment remains as free of accident hazards as is possible; and

    (2) Each resident receives adequate supervision and assistance devices to prevent accidents.

    (i) Nutrition. Based on a resident’s comprehensive assessment, the facility must ensure that a resident—

    (1) Maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident’s clinical condition demonstrates that this is not possible; and

    (2) Receives a therapeutic diet when there is a nutritional problem.

    (j) Hydration. The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health.

    (k) Special needs. The facility must ensure that residents receive proper treatment and care for the following special services:

    (1) Injections;

    (2) Parenteral and enteral fluids;

    (3) Colostomy, ureterostomy, or ileostomy care;

    (4) Tracheostomy care;

    (5) Tracheal suctioning;

    (6) Respiratory care;

    (7) Foot care; and

    (8) Prostheses.

    (l) Unnecessary drugs--(1) General. Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used:

    (i) In excessive dose (including duplicate drug therapy); or

    (ii) For excessive duration; or

    (iii) Without adequate monitoring; or

    (iv) Without adequate indications for its use; or

    (v) In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or

    (vi) Any combinations of the reasons above.

    (2) Antipsychotic Drugs. Based on a comprehensive assessment of a resident, the facility must ensure that—

    (i) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and

    (ii) Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.

    (m) Medication Errors. The facility must ensure that—

    (1) It is free of medication error rates of five percent or greater; and

    (2) Residents are free of any significant medication errors.

Associated Regulations:

Some examples include, but are not limited to, the following:

• 42 CFR 483.10(b)(11), F157, Notification of Changes

Determine whether staff notified the resident and consulted the physician regarding significant changes in the resident’s condition or a need to alter treatment significantly or notified the representative of a significant condition change.

• 42 CFR 483.(20)(b), F272, Comprehensive Assessments

Determine whether the facility assessed the resident’s condition, including existing status, and resident-specific risk factors (including potential causative factors) in relation to the identified concern under review.

• 42 CFR 483.20(k), F279, Comprehensive Care Plan

Determine whether the facility established a care plan with timetables and resident specific goals and interventions to address the care needs and treatment related to the clinical diagnosis and/or the identified concern.

• 42 CFR 483.20(k)(2)(iii), 483.10(d)(3), F280, Care Plan Revision

Determine whether the staff reviewed and revised the care plan as indicated based upon the resident’s response to the care plan interventions, and obtained input from the resident or representative to the extent possible.

• 42 CFR 483.20(k)3)(i), F281, Services Provided Meets Professional Standards of Quality

Determine whether the facility, beginning from the time of admission, provided care and services related to the identified concern that meet professional standards of quality.

• 42 CFR 483.20(k)(3)(ii), F282,Care Provided by Qualified Persons in Accordance with Plan of Care

Determine whether care was provided by qualified staff and whether staff implemented the care plan correctly and adequately.

• 42 CFR 483.30(a), F353, Sufficient Staff

Determine whether the facility had qualified nursing staff in sufficient numbers to assure the resident was provided necessary care and services 24 hours a day, based upon the comprehensive assessment and care plan.

• 42 CFR 483.40(a)(1)&(2), F385, Physician Supervision

Determine whether the physician has assessed and developed a relevant treatment regimen and responded appropriately to the notice of changes in condition.

• 42 CFR 483.75(f), F498, Proficiency of Nurse Aides

Determine whether nurse aides demonstrate competency in the delivery of care and services related to the concern being investigated.

• 42 CFR 483.75(i)(2), F501, Medical Director

Determine whether the medical director:

- Assisted the facility in the development and implementation of policies and procedures and that these are based on current standards of practice; and

- Interacts with the physician supervising the care of the resident if requested by the facility to intervene on behalf of the residents.

• 42 CFR 483.75(l), F514, Clinical Records

Determine whether the clinical records:

- Accurately and completely document the resident’s status, the care and services provided in accordance with current professional standards and practices; and

- Provide a basis for determining and managing the resident’s progress including response to treatment, change in condition, and changes in treatment. 

The Hamill Firm of Quincy, Massachusetts concentrates their practice on advocating for elderly nursing home residents and has a successful track record of verdicts and settlements including some of the highest emotional distress verdicts ever awarded in Massachusetts for nursing home abuse. The Hamill group encourages all residents injured by neglect in Massachusetts nursing homes to call for a free evaluation of their claim. 

Consumers are also invited to use the many free nursing home consumer resources available at the Hamill law firm website and blog including our free guide to avoiding abuse and our guide on selecting the safest nursing home.

Hamill Law

Understanding Certified Nursing Assistants in Nursing Homes

Direct care workers -- certified nurse aides, home health aides, and personal and home care aides -- are the primary providers of paid hands-on care for more than 13 million elderly Americans. They assist individuals with a broad range of support including preparing meals, helping with medications, bathing, dressing, getting about (mobility), and getting to planned activities on a daily basis. Although direct care workers constitute one of the largest and fastest-growing sectors of the workforce, there is a documented critical and growing shortage of these workers in every community throughout the United States. There is significant need to attract many more direct care workers in the near future.
The U.S. Department of Health and Human Services is working to improve the quality of direct care jobs and stabilize this workforce on a number of fronts. For over a decade, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) has made the direct care workforce a major focal point of its policy research agenda. ASPE has convened expert meetings and conferences; produced seminal reports and reports to Congress on the long-term care workforce; reviewed state-based policies and provider practice initiatives; examined the utility and efficacy of worker registries, background checks, and wage pass-throughs; explored potential new sources of new workers; and sponsored a number of program evaluations and demonstrations. The Patient Protection and Affordable Care Act (P.L. 111-148) strengthens the investment in direct care work by authorizing several new initiatives aimed at improving the quality of direct care jobs, workforce development, and long-term care.
This chart book highlights findings from two new ASPE-sponsored national surveys: The 2004 National Nursing Assistant Survey and the 2007 National Home Health Aide Survey. Both surveys represent a major advance in the data available about two of America’s most important jobs -- certified nursing assistants working in nursing homes and home health aides working in home and hospice care settings. The chart book is intended to help multiple audiences understand these jobs, issues, and challenges; and to establish useful benchmarks as goals toward which improvement efforts might aspire.
Understanding Direct Care Workers: A Snapshot of Two of America’s Most Important Jobs -- Certified Nursing Assistants and Home Health Aides

Nation’s Largest Nursing Home Pharmacy and Drug Manufacturer to Pay $112 Million to Settle False Claims Act Cases

The nation’s largest nursing home pharmacy, Omnicare Inc. of Covington, Kentucky, will pay $98 million, and drug manufacturer, IVAX Pharmaceuticals of Weston, Florida, will pay $14 million to resolve allegations that Omnicare engaged in kickback schemes with several parties, including IVAX, the Justice Department announced today. Approximately $68.5 million of the settlement proceeds will go to the United States, while $43.5 million has been allocated to cover Medicaid program claims by participating states.

Nation’s Largest Nursing Home Pharmacy and Drug Manufacturer to Pay $112 Million to Settle False Claims Act Cases

Resident "behaviour issues" in Nursing Homes

I attended a criminal sentencing in a Massachusetts Superior Court for an aide who had been found guilty of 4 counts of assaults on and mistreatment of nursing home elder residents. The sentencing Judge did not sentence the aide to jail because,  astonishingly, he apparently felt sympathy for the aide. Th CNA (Certified Nurse Aide) had been "forced " to work too many hours. And the residents she cared for were sometimes difficult if not "violent" because they had suffered from Alzheimer's disease. As if "resistance" by an ill resident justifies criminal retaliation! Educating the judiciary has become a constant theme in bringing civil cases. Most are unaware or pay lip service to very strict federal regulations prohibiting abuse. state regulations also prohibit abuse:
42CFR§483.13 Resident Behavior and Facility Practices
§483.13(b) Abuse (Ftag 223)
"The resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion."
Each resident has the right to be free from abuse, corporal punishment, and involuntary seclusion. Residents must not be subjected to abuse by anyone, including, but not limited to, facility staff, other residents, consultants or volunteers, staff of other agencies serving the resident, family members or legal guardians, friends, or other individuals.

“Abuse” means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.” (42 CFR §488.301)
This also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. This presumes that instances of abuse of all residents, even those in a coma, cause physical harm, or pain or mental anguish.
“Verbal abuse” is defined as the use of oral, written or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance, regardless of their age, ability to comprehend, or disability. Examples of verbal abuse include, but are not limited to: threats of harm; saying things to frighten a resident, such as telling a resident that he/she will never be able to see his/her family again.
“Sexual abuse” includes, but is not limited to, sexual harassment, sexual coercion, or sexual assault.
“Physical abuse” includes hitting, slapping, pinching and kicking. It also includes controlling behavior through corporal punishment
“Mental abuse” includes, but is not limited to, humiliation, harassment, threats of punishment or deprivation.
§483.13(c) Staff Treatment of Residents ( F224 and F226)
The facility must develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property.

§483.13(c)(1)(i) Staff Treatment of Residents
(1) The facility must (i) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion;
Our office represented 3 of the victims of this criminal conduct. We were much more successful than the attorney general in bringing justice to the families. At trial, victims who were assaulted and or mistreated received judgements of $300,000, $450,000 and an a third case resulted in a trial settlement.

Residents Rights in Nursing Homes

Federal Regulations (42CFR§483.10) require that in a nursing home setting: "The resident has a right to a dignified existence (see also §483.15(a) Dignity) self-determination, and communication with and access to persons and services inside and outside the facility. A facility must protect and promote the rights of each resident, including each of the following rights" 42CFR§483.10
Residents Rights are not only good medicine, they are mandated by Federal; and state laws and make up the Standard of Care in nursing homes.
These rights include the resident’s right to
• Exercise his or her rights (§483.10(a));
• Be informed about what rights and responsibilities he or she has (§483.10(b));
• If he or she wishes, have the facility manage his personal funds (§483.10(c));
• Choose a physician and treatment and participate in decisions and care planning (§483.10(d))
Other rights include:
§483.10(e) Privacy and Confidentiality
§483.10(f) Grievances
§483.10(g) Examination of Survey Results
§483.10(h) Work
§483.10(i) Mail
§483.10(j) Access and Visitation Rights
§483.10(k) Telephone
§483.10(l) Personal Property
§483.10(m) Married Couples
§483.10(n) Self-Administration of Drugs
§483.10(o) Refusal of Certain Transfers

Attorney Hamill has 34 years experience advocating for injured people including those who have suffered from nursing home neglect, abuse or wrongful death. The Hamill firm represents elders victimized by criminal assaults , bed sores, falls from Hoyer lifts, sepsis and malnutrition. For more information contact the Hamill group at (617) 479-4300 or use the firm's website contact form.

Admitting Past Felons into Nursing Homes

The Desmoine Register had this article the same day I wrote about placement of past felons in nursing homes and how they increase risk of crimes upon nursing home residents.
State officials say doctors did not view convicted sex offender William Cubbage as a sexual predator when they recommended moving him to an Iowa nursing home where he’s now suspected of sexually assaulting an elderly woman. At one time, a psychologist hired by the state believed Cubbage had victimized “a large number of female children” without being charged or prosecuted for those offenses, according to court records.
Two decades of sex crimes in nursing home abuse suspect’s past The Des Moines Register DesMoinesRegister.com

With violent attacks by felons living in some nursing homes, some facilities are scrambling to comply with disclosure laws required in some states to notify state public health officials when they admit offenders. The number of felons reported to be living in the facilities increased last month in some states. Past reported felonious acts have included rape, theft, assaults, illegal drug use and violence. Some former felons also have serious psychiatric conditions.
http://www.lawfirmnewswire.com/2011/11/massachusetts-elder-abuse-lawyer-warns-of-danger-of-admitting-past-felons-to-nursing-homes/

Elder Pain Study Shows Disparity in Races

According to a study conducted to measure pain in elderly nursing home residents showed a marked disparity between racial groups:
- About one-quarter of all nursing home residents reported or showed signs of pain.
- Forty-four percent of nursing home residents with pain received neither standing orders for pain medication nor special services for pain management (i.e., appropriate pain management).
- Among residents with dementia and pain, nonwhite residents were more likely than white residents to lack appropriate pain management.
- a significantly greater proportion of residents without dementia reported pain compared with residents with dementia.

Over 40% of all nursing home residents with pain received neither standing orders for pain medication nor special services for pain management. Among residents with dementia and pain, there were differences in appropriate pain management between nonwhite and white residents, with nonwhite residents being more likely than white residents to lack appropriate pain management. Questions exist as to the disparity of adequate pain relief for non white residents. Is it because the facilities they are in are inferior and lack adequate resources?

Products - Data Briefs - Number 30 - March 2010

Pressure Ulcers v Deep Tissue Injury vs Blisters ll

Afte publishing the post about Pressure Ulcers v Deep Tissue Injury vs Blisters I received an excellent email from Sue Hull, MSN, RN, CWOCN, who operates WoundConsultations.com
"The reason DTI is discussed along with pressure ulcers in the NPUAP document is because it is caused by pressure. If it occurs while a person is a resident of a nursing home, it would indicate negligence in that the measures had not been taken to prevent pressure. I believe it is standard care that a pressure ulcer risk assessment is done on admission and at predetermined intervals thereafter in nursing homes (as in home health, where I work). Based upon the findings of the risk assessment, interventions are to be implemented to prevent skin breakdown. If DTI develops, something was missed in the process, or something is wrong with that particular nursing home's process.

If there were factors that truly did make the DTI unpreventable, those factors should be copiously documented. It should never be a surprise when a pressure ulcer develops. Eg. if a resident MUST have the head of the bed in a high Fowler's position to breathe, it should be heavily documented along with the skin assessment, and a sacral DTI should be watched for. It should not be a surprise.
Also, when there is DTI, it is not undectible, even in persons of color. There are changes, such as warmth, bogginess, blood filled blisters, and color changes. If boney prominence are routinely checked for these things, the DTI will be detected."
Thanks for your input Sue.

http://malpractice.blogspot.com/2011/11/pressure-ulcers-vs-deep-tissue-injury.html

Nursing homes report more felons

What happens when an elder applies to a nursing home who is a convicted felon or a dangerous criminal? What safety meassures are taken by the nursing home to protect the elder residents from predatory actions such as sexual assaults and criminal assaults? Shouldn't they be screened for the protection of all residents? Shouldn't residents families be warned about these types of admissions?
Nursing homes report more felons - chicagotribune.com