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Treatment of Decubitus Cicers An t-risk patient can develop a press wure we with only two to six hours of mee who testified as an expert witness for Viewed in detail aspects of the legal beginning of the shift and your resident first noted a large discolored Skin Care: Court Awards Damages To Family For Patient’s Death From Decubitus Ulcers. The US District Court for he District of Oregon awarded the family 5125,000 The nursing progress from US Government for the de notes in the chart are in welieved pressure on sensitiwi, ale death from sepsis and multi-orgun fallure complete and internally in ording to experienced wound care related to decidetur lors contracted a consistent hospital The nurses are permitted the family’s case In it longdy ruling the Cowto simply fo chart “Q2” at the The physical theraplot and second dard of care for nurses caring for patients we ce the buttocks and nor document each two- dered a wound care consult that me day with skie-integrity issues Nursing Assessment hour turning of the patient. No one saw to it that a wound care special The sixty year-old patient had a his and the nurses festified that ist came in weil one week later, violation tory of alasholism and smoking. He had was their routine practice. of the hospital’s own internal skin care had a triple coronary artery bypass, cardjac policies However, the actual prac. catheterization and cardie deftillator The hospital’s own policies required and had hypertensi, COPD, peripheral tice seemed to have been to any change in the patient’s condition with vascular disease and chronic es Sallure. chart “Q2” at the beginning regard to decubitus ulcers berorted to lower Say Wobection to hang canceYo chart position changes was not done Hdmission was for a right of every shift and then also the patient’s attending physician, but that After sey he was sent to the ICU. as they occurred sporadi- An ICU nurse made a noe some days At this bospital the Braden Scale is later that the skin on the battockspot used to cech i plina’t risk of cally throughout the day. tinuing to deteriorate since surgery and that breakdown arki integrity. The plant the family testified he was the patient was to be kept of his backside oor was 20 admission to the ICU and often not repositioned as much as possible. Nevertheless, later never fell below all times at high risk According to the Court decubitus every two hours. that day the patient was left lying on his ulcerse many cases preventable and In any event, once the back for three hours and then moved to his Chair for nine hours, twelve hours of pre- primary method of prevention is frequent decubitus ulcers appeared, sure bearing down on the buttocks lesions firning of the patient heightened scrutiny The wound care consult finally did Turning/Documentation vigilance were required, in- come, but from a nurse who was not yet The testimony in the trial was that the cluding thorough and accur certified for wound care management who mers had practice of turning immobile patients every two hours. However, the was filling in for the regular wound cato rate documentation of the Court was unable to find documentation on patient’s position changes. nurse who was out co maternity leave. the ICU flow sheels af in the nursing pro Her assessment of the staging of the If oxygen desaturization wounds wis not accurate, according to the gress notes of it baving been done. The day following surgery the ICU from turning him every two was preventing the nurses Court, and misstated the severity of what flow sheet documented the patient as “self was actually going on. The physical de tice regarding skin integrity lasues for been documented and the she rated there merely at Stage II. turning” but that was the only documents hours, that should have scriptions of what she saw would place the buttocks lesions at State III or TV, while twelve hout period. At 5:00 am the next nurses should have re- day the patient was listed as “02” turns, quested an order to in- tocks wounds but the ICU nurses did not Drainage began coming from the but- but no actual taning was documented until crease his oxygen prior to actually see the wounds which were cov- 1:00 pm, that afternoon, The Court found that the documente turning him and/or to pre-ered by creams and dressings. The nurses sistent. From that fact the court concluded anxiety drugs to reduce his tion in the chart was incomplete and incon medicate him with anti- simply noted that the wounds were dit- cult to assess for that reason that the patient more likely thar nok was, anxiety upon turning him. The patient began to have issues with not being properly repositioned every two UNITED STATES DISTRICT COURT fecal incontinence, but the care plan was hours as required by the standard of care OREGON not updated and nothing was done. The for an immobile patient and by the hospi- October 9, 2012 lab values began to show systemic infec tion from the infected wounds. Delahanty ys, 2012 WL 4734147 (D. Or, October 9, 2012). Legal Eagle Eye Newsletter for the Nursing Profession and tal’s own internal policies. November 2012 Page 2
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