Minimizing the Legal Issues Around Pressure Injury Care Editorial Summary In skilled nursing facilities, it is estimated that up to 28% of patients suffer pressure injuries.1 The numbers increase dramatically with patients in high-risk groups such as quadriplegics suffering pressure ulcer injuries.2 Because some pressure injuries may be preventable with proper nursing care, these cases are often ripe for litigation.2 This article is an overview of how legal issues can be minimized around pressure injury care.
Introduction
Federal and State Regulations
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t is estimated that each year between 1 and 3 million people in the United States develop pressure injuries.1 In skilled nursing facilities, it is estimated that up to 28% of patients suffer pressure injuries.1 The numbers increase dramatically with patients in high-risk groups such as quadriplegics suffering pressure ulcer injuries.2 Because some pressure injuries may be preventable with proper nursing care, these cases are often ripe for litigation.2 The Legal Nurse Consultant (LNC) can play an invaluable role in reviewing these cases and assisting throughout litigation. The LNC must have an understanding of the federal nursing home regulations, the various practices behind prevention and treatment of pressure injuries, and nursing home documentation. These federal regulations require unique charting that differs from hospital records, including the Minimum Data Sets (MDS) and Resident Assessment Protocols (RAP sheets). In addition, to understanding the medical, nursing, and charting issues, the LNC should have a basic understanding of the legal aspects of a pressure ulcer/injury case.
Ms Kathleen Martin Legal Nurse Consultant Cave Creek AZ, United States
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A pressure injury case, at the most basic level, requires the plaintiff to prove these elements: •
The health care provider owed a duty of care to the patient
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The duty was breached. The provider was negligent or committed malpractice
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The patient suffered an injury
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The injury was caused by the provider’s breach of the duty *
Wound Masterclass - Vol 1 - December 2022
Nursing homes are among the most heavily regulated businesses in the country. In 1987, Congress passed the Omnibus Budget and Reconciliation Act (OBRA) also called the Nursing Home Reform Act. The regulations both generally and specifically address a nursing home’s duties to prevent and treat pressure injuries. The regulations impose a high standard on nursing facilities regarding the prevention and proper treatment of pressure injuries. The facility providers have a duty to ensure: A resident who enters a facility without pressure injuries does not develop pressure injuries unless the individual’s clinical condition demonstrates that they were unavoidable; and A resident having pressure injuries receives necessary treatment and services to promote healing, prevent infection and prevent new injuries from developing. It might be important that when investigating a pressure injury case against a nursing home that the LNC review at least three years of surveys by the state’s health department. These surveys may reveal a pattern of neglect. Such surveys, if not provided to the LNC/Expert may not use them in the report or other testimony developed by the LNC. The survey reports may be the foundation for building a punitive damage claim. Punitive damages are an additional recovery for the plaintiff. They are intended to punish the
* Prosser, Keeton, Dobbs, & Keeton, 1984; Morrison v. MacNamara, 1979; Weimer v. Hetrick, 1987; Mitchell v. Parker, 1984. © Copyright. Wound Masterclass. 2023