A Failure to Reposition a Nursing Home Resident Leads to Pressure Sores
The allegation was that a resident was provided inadequate nursing care when due to a failure to reposition the resident and treat coccyx pressure ulcers. The allegations were substantiated. Staff failed to inform physician or provide any treatment for the coccyx area for approximately two weeks and as a result the resident developed a stage two pressure ulcer.
NOTE: The following information about the facility and provider is provided by the MDH Website this blog is not a complete list of providers with Substantiated Complaints, the providers highlighted are generally those which focus on the care of disabled or elderly persons.
Pursuant to Minnesota Statute 626.5572, subd. 19; “Substantiated” means a preponderance of the evidence shows that an act that meets the definition of maltreatment, which is defined subdivision 15, as: means “abuse as defined in subdivision 2, neglect as defined in subdivision 17 or financial exploitation as defined by subdivision 9.”
According to: National Pressure Ulcer Advisory Panel Staging of Ulcers
Has a detailed description of the various Stages of Pressure Ulcers also known as Decubitus Ulcers and Bed Sores
The site shows skin conditions in each Stage:
A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.
Failure to Reposition – Pressure Ulcer Stages/Categories
Category/Stage I: Non-blanchable erythema
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Category I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons.
Category/Stage II: Partial thickness
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or sero-sanginous filled blister.Presents as a shiny or dry shallow ulcer without slough or bruising*. This category should not be used to describe skin tears, tape burns, incontinence associated dermatitis, maceration or excoriation.
*Bruising indicates deep tissue injury.
Category/Stage III: Full thickness skin loss
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. The depth of a Category/Stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and Category/Stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep Category/Stage III pressure ulcers. Bone/tendon is not visible or directly palpable.
Category/Stage IV: Full thickness tissue loss
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often includes undermining and tunneling. The depth of a Category/Stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and these ulcers can be shallow. Category/Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis or osteitis likely to occur. Exposed bone/muscle is visible or directly palpable.
Additional Categories/Stages for the USA
Unstageable/Unclassified: Full thickness skin or tissue loss – depth unknown
Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Until enough slough and/or eschar are removed to expose the base of the wound, the true depth cannot be determined; but it will be either a Category/Stage III or IV. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.
Suspected Deep Tissue Injury – depth unknown
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue. Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.
Failure to Reposition – If you suspect a loved one is suffering from a Pressure Ulcer, PLEASE TAKE IMMEDIATE ACTION!
For more information regarding Pressure Ulcers please look at the National Pressure Ulcer Advisory Panel website located at: http://www.npuap.org/resources.htm
Although, efforts are made to make accurate links and relayed information, these blogs are examples of neglect and other issues, please double check all information at: MDH Website
This website is not intended to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation.
If you or a loved one has suffered a pressure sore injury or an injury from neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact our firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact Attorney Kenneth L. LaBore, directly please send an email to KLaBore@MNnursinghomeneglect.com or call Ken at 612-743-9048.