Archive for the ‘Pressure Ulcers’ Category

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Stage IV Pressure Sore Suffered by Resident at the Estates at Bloomington

Written By: Kenneth LaBore | Published On: 19th March 2017 | Category: Pressure Ulcers, Wound Care | RSS Feed
NPUAP Stage 4 Pressure Injury with Epibole - Neglect at Golden Living Center Bloomington AKA the Estates at Bloomington

NPUAP Stage 4 Pressure Injury with Epibole – Neglect at Golden Living Center Bloomington AKA the Estates at Bloomington

Substantiated Neglect After Serious Pressure Sores at the Estates at Bloomington

In a report dated August 25, 2017, the Minnesota Department of Health cited Golden LivingCenter in Bloomington now know as the Estates at Bloomington with neglect after a resident developed a stage IV pressure ulcer at the facility.

Pressure Ulcer Wounds Develop for Resident at the Estates at Bloomington

Based on a preponderance of the evidence, neglect occurred when the facility failed to adequately assess, monitor, and implement interventions to prevent and heal pressure ulcers.  The resident re-developed coccyx/buttocks pressure ulcers, which worsened.

The resident was admitted to the facility with a sacral pressure ulcer.  Staff implemented interventions to prevent the development of additional pressure ulcers.  Over the next several months, the sacral pressure ulcer healed, re-developed, and healed again.  New interventions were implemented; however, the resident’s care plan, and direct care staff aside sheet were not kept up to date with instructions for direct staff on how frequently to turn and reposition the resident.

Approximately two months after the last pressure ulcer healed, the resident developed two stage two pressure ulcers to her/his coccyx/buttocks.  Staff did not notify or obtain orders for treatment from the physician until 28 days later, when the ulcers had worsened and resident had four open areas to her/his buttocks.  One week later, the resident went to the hospital due to a decrease in responsiveness and a temperature of 101.6 degrees Fahrenheit.

According to the records, the hospital admitted the resident with a diagnosis of sepsis as well as a catheter associated urinary tract infection.  Upon admission into the hospital, the resident’s pressure ulcers had necrotic tissue with surrounding skin cellulitis.  The sacral bone was exposed.

When interviewed, the nurse practitioner stated s/he had never previously examined the resident’s pressure ulcers due to resident refusals.  The nurse practitioner was not informed of the pressure ulcers redevelopment until approximately one month after staff observed the new pressure ulcers.  The nurse practitioner indicated the facility’s lack of monitoring, and delay in treatment contributed to the worsening of the resident’s pressure ulcers.

The resident did not return to the facility.

Report Suspected Neglect Pressure Ulcers and Wounds – the Estates at Bloomington

Click Here For Link To Report Abuse To Adult Protection

Click Here For Link To Report Abuse To Adult Protection

For more information from the Minnesota Department of Health, Office of Health Facility Complaints concerning nursing homes, assisted living and other elder care providers view resolved complaints at the MDH website.

If you have concerns about pressure ulcers or any other form of elder abuse or neglect contact Minnesota Elder Abuse Attorney Kenneth LaBore toll free at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

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Free Consultation on Issues of Elder Abuse and Neglect Serving all of Minnesota Toll Free 1-888-452-6589

Free Consultation on Issues of Elder Abuse and Neglect Serving all of Minnesota Toll Free 1-888-452-6589

 

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KSMS Our House Austin Neglect Substantiated

Written By: Kenneth LaBore | Published On: 18th March 2017 | Category: Bed Sores and Pressure Ulcers, Failure to Resond to Change in Condition, Pressure Ulcers, Wound Care | RSS Feed
Failure to Provide Proper Wound Care and Assessment - Pressure Sores - Ulcers - KSMS Our House in Austin Minnesota

Failure to Provide Proper Wound Care and Assessment – Pressure Sores – Ulcers – KSMS Our House in Austin Minnesota

KSMS Our House Austin Cited with Neglect After Serious Wounds

In a report from the Minnesota Department of Health dated, February 13, 2017, it is alleged that a client at KSMS Our House in Austin Minnesota was neglected when s/he presented to the hospital with an elevated temperature, a leg severely bruised with blisters, and a large ulcerated sore on his/her tailbone that was infected.

Negligence Supported Against KSMS Our House After Ulcerated Sore

Based on the report a preponderance of evidence, neglect occurred when the facility failed to provide proper care and treatment of the client’s coccyx, buttock, and heel wounds.  The client had recurrent problems with wound healing for over two years .  The facility Registered Nurse (RN) failed to provide adequate wound assessment and monitoring of the client’s wounds, and failed to provide direction and training to direct care staff who were to performing the delegated nursing task of wound care.

The client was cognitively impaired and was completely reliant on caregivers for all activities of daily living.  The client could not walk and was transferred by two staff with a mechanical lift. The client was incontinent of bowel and bladder and staff performed the client’s incontinence care.  The client had pressure sores on the coccyx and left heel for over two years.  Direct care staff performed the client’s daily wound treatments, without any written instructions or training by the RN.

The client’s only wound assessment by the facility RN was completed in 2014.  At that time, the client had a stage II pressure ulcer on the inside of the right buttock measuring 2 centimeters (cm) x 1.5 cm.  There was no evidence of further RN oversight of the client’s wound.  The client’s medical record was void of any wound assessments, pertaining to the client’s heel ulcer.

In March 2016, a hospital record indicated that the client still had the stage II pressure ulcer on the right buttock and had also developing stage II pressure ulcer on the sacrum.  Discharge orders to the facility including instructions for dressing changes and instructions to frequently change the client’s position.

In May 2016, direct care staff documented that the client had a “big open sore on her bottom” and the client’s family member took the client to the hospital for evaluation.  A culture of the wound drainage was taken.  Hospital discharge orders provided to the facility included instructions for dressing changes, including the application of antibiotic ointment for ten days.

In July 2016, a hospital record indicated that the client had multiple areas of dermis loss on the buttocks and inner groin, including a 4.5 cm x 0.7 cm open lesion on the left inner groin, a 3.5 x 2.0 cm open ulceration on the right lower buttock, a 4.5 cm x 2.0 cm open ulceration on the right buttock, a 0.3 cm x 5.0 cm open ulceration on the gluteal fold, and two open areas on the left buttock measuring 0.5. cm x 0.5 cm and 0.5 cm x 0.8 cm.  All areas were macerated.  Hospital discharge orders were provided to the facility including instructions for wound care, perineal care, and to document the client’s wound healing each day.

In August 2016, a hospital record indicated that the client had an unstageable ulcer on the left heel and the client was admitted for hospitalization due to osteomyelitis of the heel wound with culture results positive for MRSA and Strep.  The client underwent a surgical limb salvage procedure for the left heel.  The client’s buttock and groin wounds were also evaluated during hospitalization.  Hospital discharge orders provided to the facility included instructions for wound treatment and care of the surgical incision, which entailed application of an ace wrap to the client’s left leg.

In September 2016, a hospital record indicated that the client was emergently hospitalized due to a change in condition.  On hospital arrival, the client was unresponsive, had a fever of 101 degrees, oxygen saturations not above 87% on six liters of oxygen, bilateral blue feet, and a left lower leg that was red and swollen with fluid-filled blisters.  The client was admitted to the ICU with polymicrobial infections of the left leg, sacrum and urinary tract, along with pneumonia.  The client’s condition did not improve with volume resuscitation and broad-spectrum antibiotics.  Comfort measures were elected and the client was discharged to a skilled care facility on hospice care.

All of the client’s hospital visits from March 2016 to September 2016 were facilitated by the client’s family member, based on reports direct care staff gave the family member about the deteriorating condition of the client’s wounds.  During the same time period from March 2016 to September 2016, multiple direct care staff had informed the RN that the client’s wounds were worsening, looked infected, and had drainage that soaked through the dressings.  There was no evidence that the RN ever addressed the client’s wound, monitored the status of the client’s wounds for healing, or followed up on the culture results.  The client’s medical record was void of any wound assessments from March 2016 to September 2016 and void of any progress notes or evidence of follow-up about the client’s wound culture.  During the period March 2016 to September 2016, direct care staff performed the client’s wound dressings, without any evidence of training by the RN including the safe handling of contaminated materials.  The client’s care plan completed by the RN did not contain any information about the client’s wounds.

After the client had the left heel surgical procedure in August 2016, hospital discharge instructions included application of an ace wrap to the client’s left leg following incision care.  Only the RN applied the client’s ace wrap.  There was no evidence that the RN monitored the client’s left leg for circulation, motor ability, or sensation.  When the client was re-hospitalized in September 2016, the hospital record noted that the client’s left lower leg had an “an ace wrap that was bound too tightly” causing the appearance of “rug-burns”, in addition to an obvious cellulitis of the lower extremity which was red and swollen with fluid blisters.

When interviewed, the facility RN had no explanation regarding the inadequate nurse oversight of the client’s wounds.

__________________________

Tibia Fracture - Allegation of Neglect - Fractured Tibia - KSMS Our House in Austin

Tibia Fracture – Allegation of Neglect – Fractured Tibia – KSMS Our House in Austin

Tibia Fracture to Client Leads to MDH Complaint of Neglect Against KSMS Our House

In a report from the Minnesota Department of Health, dated February 13, 2017, it was alleged that a client at KSMS Our House in Austin Minnesota was neglected when s/he had a fall.  The client had progressively worse pain after the fall and it was discovered ten days later that the client had a tibia fracture.

Substantiated Neglect Complaint After Client Fractures Tibia in Fall

Based on the report a preponderance of evidence, neglect occurred when the facility failed to thoroughly assess the client after a fall, monitor the client’s change in condition, and intervene with proper nursing care that addressed the client’s acute needs.  Ten days after the fall, it was discovered that the client had a broken leg.

The client used a wheelchair propelled with his/her feet.  Due to unsteadiness when standing, balance problems, and history of falls, the client needed the assistance of one staff to stand and pivot for transfers.  The client needed the assistance of one staff for all activities of daily living.  The client could verbally express his/her needs and desires.  The client lived alone in an apartment and wore a pendant that s/he could push to alert staff when s/he needed help.

During a night in July 2016, the client paged staff at 3:45 a.m. because s/he had fallen in his/her apartment.  Direct care staff responded and found the client sitting on the floor.  The client told staff that his/her knees hurt.  After the client fell, the client was not thoroughly assessed by a nurse at any time for ten days, even though multiple direct care staff repeatedly reported to the RN the client’s symptoms of leg pain, leg swelling, bruising, difficulty with transfers, and inability to propel the wheelchair independently.  Ten days after the fall, the client’s family member took the client to the hospital due to the client’s complaints of ongoing severe leg pain.

The client’s hospital record indicated that the client had severe pain with movement and positive changes of the right leg and decreased range of motion in the right knee.  The client’s right and left anterior knees had diffuse bruising with greater bruising on the right lateral tibia, and right upper arm.  The client’s right calf was red, swollen, and warm to touch and was suspicious for cellulitis.  X-rays confirmed the client had a right tibial plateau fracture.  Conservative management of the fracture was elected.  The client was hospitalized to treat the cellulitis with intravenous antibiotics.  During hospitalization, the client declined with acute kidney injury and altered mental status.  After being hospitalized for seven days, the client was discharged to a skilled care facility.

The facility has a full-time Registered Nursing (RN) and nurses on-call at all times, when the facility’s RN is not onsite.  There was no evidence that a nurse thoroughly assessed the client’s status at any time during the ten days the client exhibited symptoms of fracture.  The facility’s RN made only two brief progress notes (a note two days after the fall and another note the day before the client went to the hospital) which did not include any detailed assessment information or address changes in the client’s condition that had been reported by direct care staff.  The facility’s medical record was void of any nursing progress notes prior to the client’s fall.

Statements by the facility’s RN concerning the client’s post-fall status were contradictory to multiple interviews of the direct care staff who provided care to the client after the client fell.

__________________________

 

Failure to Assess Change in Condition Fractured Leg

Failure to Assess Change in Condition Fractured Leg, KSMS Our House Austin

KSMS Our House Austin Complaint Findings for Neglect – Failure to Assess

In a report concluded on November 13, 2014, the Minnesota Department of Health cites KSMS Our House Austin for neglect of health care failure to assess change in condition.

It is alleged that neglect of health care occurred when the alleged perpetrator (AP) failed to assess a client #1’s pain.  The client had a broken leg.  In addition; the AP failed to send another client #2 to the hospital in a timely manner after a change in health status.

Substantiated Neglect Against KSMS Our House Austin

Based on preponderance of evidence neglect did occur when a client’s change in condition was not assessed by the AP to ensure timely medical intervention.

The client had diagnoses that included diabetes mellitus, chronic obstructive pulmonary disease (COPD), Coronary Artery Disease (CAD) and Asthma.  The client received assistance of one staff with activities of daily living (ADL) skills that included walking, medication administration, and daily accuceheck (blood sugar monitoring).  The client was independent with administration of his/her insulin injections.  The client’s medication regimen included pain control of Oxycodone (narcotic) 30 milligrams (mg) extended release tablets take one tablet by mouth every 12 hours. Oxycodone/APAP (narcotic) 5-325 mg tablet; take one or two tablets by mouth every 4 -6 hours as needed for pain.

On the morning of the client’s change in condition at 8:00 a.m., the staff identified, the client was “pretty out of it”.  The client had oxygen levels of 86% to 93%, required assistance to put medications in his/her mouth, and was unable to self-administer the insulin.  The staff notified the AP of the client’s change in condition.  The AP instructed staff to administer the client’s insulin, but did not assess the client’s condition in relation to the altered mental status and inability to self-administer medications.  The AP did not provide the staff with any parameters for monitoring the client or when to call the AP back.  In addition, the AP informed the staff not to call 911 unless the client was unconscious.  Later the same day, on the evening shift of work, the client was not able to stand up.  The staff notified the AP of the client’s inability to stand.  The AP instructed staff to use a mechanical lift for transfers without an assessment of the client’s status or provide the staff with any parameters for monitoring the client or when to call the AP back.  Eleven hours after the first reported change in condition had not improved and staff identified the client had an oxygen level of 86%, and a temperature of 101.5.  Staff did not call the AP for direction instead called 911 and the client was transported to the hospital and admitted to the hospital intensive care with a diagnosis of Toxic/metabolic Oxycodone, intermittent myoclonic jerks, acute delirium and pneumonia – likely from aspiration.  The client returned to the facility after a five-day hospital stay.

For more information from the Minnesota Department of Health, Office of Health Facility Complaints concerning nursing homes, assisted living and other elder care providers view resolved complaints at the MDH website.

If you have concerns about a failure to assess a change in condition, falls, fractures or any other form of elder abuse or neglect contact Elder Abuse and Neglect Attorney Kenneth LaBore at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

Disclaimer

Nursing Home Abuse and Neglect Lawyer Kenneth LaBore Offers Free Consultations and Serves Clients Throughout the State of Minnesota Call Toll Free at 1-888-452-6589

Nursing Home Abuse and Neglect Lawyer Kenneth LaBore Offers Free Consultations and Serves Clients Throughout the State of Minnesota Call Toll Free at 1-888-452-6589

 

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Bedsore Injury

Written By: Kenneth LaBore | Published On: 3rd February 2017 | Category: Bed Sores and Pressure Ulcers, Failure to Resond to Change in Condition, Nursing Home Abuse and Neglect, Pressure Ulcers | RSS Feed
Nursing Home Bedsore Injury is Preventable

Nursing Home Bedsore Injury is Preventable

Bedsore Injury Injuries Are Preventable

Bedsore injury is preventable with proper care and treatment and sufficient staff at nursing homes and other elder care facilities to ensure that residents who need assistance are turned and repositioned at least every two hours to assure that they do not have long periods of time without pressure relief.  There are several points of the body that are more prone to bed sore pressure ulcers, including the back of the head, shoulder, buttocks, coccyx, and back of heels.

Bedsore Injury Stages

According to the Mayo Clinic, bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, defines each stage as follows:

Stage 1

The beginning stage of a pressure sore has the following characteristics:

  • The skin is not broken.
  • The skin appears red on people with lighter skin color, and the skin doesn’t briefly lighten (blanch) when touched.
  • On people with darker skin, the skin may show discoloration, and it doesn’t blanch when touched.
    The site may be tender, painful, firm, soft, warm or cool compared with the surrounding skin.

Stage 2

At stage 2:

  • The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
  • The wound may be shallow and pinkish or red.
  • The wound may look like a fluid-filled blister or a ruptured blister.

Stage 3

At stage 3, the ulcer is a deep wound:

  • The loss of skin usually exposes some fat.
  • The ulcer looks crater-like.
  • The bottom of the wound may have some yellowish dead tissue.
  • The damage may extend beyond the primary wound below layers of healthy skin.

Stage IV

A stage IV ulcer shows large-scale loss of tissue:

  • The wound may expose muscle, bone or tendons.
  • The bottom of the wound likely contains dead tissue that’s yellowish or dark and crusty.
  • The damage often extends beyond the primary wound below layers of healthy skin.

Unstageable

A pressure ulcer is considered unstageable if its surface is covered with yellow, brown, black or dead tissue. It’s not possible to see how deep the wound is.

Deep tissue injury

A deep tissue injury may have the following characteristics:

  • The skin is purple or maroon but the skin is not broken.
  • A blood-filled blister is present.
  • The area is painful, firm or mushy.
  • The area is warm or cool compared with the surrounding skin.
  • In people with darker skin, a shiny patch or a change in skin tone may develop.

Bedsore Injury Skin Care

Residents must receive necessary skin care to help prevent pressure  and bedsore injury.  According to Minnesota Administrative Rule 4658.0520, Subpart (2)(B), clean skin and freedom from offensive odors. A bathing plan must be part of each resident’s plan of care. A resident whose condition requires that the resident remain in bed must be given a complete bath at least every other day and more often as indicated. An incontinent resident must be checked at least every two hours, and must receive perineal care following each episode of incontinence. Clean linens or clothing must be provided promptly each time the bed or clothing is soiled. Perineal care includes the washing and drying of the perineal area. Pads or diapers must be used to keep the bed dry and for the resident’s comfort. Special attention must be given to the skin to prevent irritation. Rubber, plastic, or other types of protectors must be kept clean, be completely covered, and not come in direct contact with the resident. Soiled linen and clothing must be removed immediately from resident areas to prevent odors.

Bedsore Injury Must Be Reported

According to Minnesota Statute 144.7065, each facility shall report to the commissioner the occurrence of any of the adverse health care events described in subdivisions 2 to 7 as soon as is reasonably and practically possible, but no later than 15 working days after discovery of the event. The report shall be filed in a format specified by the commissioner and shall identify the facility but shall not include any identifying information for any of the health care professionals, facility employees, or patients involved. The commissioner may consult with experts and organizations familiar with patient safety when developing the format for reporting and in further defining events in order to be consistent with industry standards.

The statute requires the reporting to the Commissioner of the Department of Health, stage 3 or 4 or unstageable ulcers acquired after admission to a facility, excluding progression from stage 2 to stage 3 if stage 2 was recognized upon admission.

Additional Information on Bedsore Injury

Also see some of my other blogs on this topic:

Bedsore Stages

Pressure Injury Stages

Pressure Sore Injury

Pressure Injuries

Bedsore Injury Neglect Attorney

If you have questions about nursing home abuse and neglect contact Kenneth LaBore for a free consultation.  There is no fee unless there is a verdict or settlement offer from the wrongdoer.  Mr. LaBore can be reached directly at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

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Pressure Sore Injury

Written By: Kenneth LaBore | Published On: 3rd February 2017 | Category: Bed Sores and Pressure Ulcers, Pressure Ulcers | RSS Feed
Nursing Staff Providing Wound Care for Pressure Sore Injury

Nursing Staff Providing Wound Care for Pressure Sore Injury

Nursing Home Pressure Sore Injury

Residents of nursing homes have a few areas of risk that are the greatest, some like falls, being dropped from lifts, medication mistakes, sexual and physical abuse are obvious forms of neglect.  Pressure sore injury is usually neglect that occurs over a period of time and due to a failure to relieve pressure usually aggravated by other factors such as a lack of nutrition and hydration and issues with sanitation and hygiene in the subject facility.

Pressure Sore Injury is Preventable

According to federal regulations, based on the comprehensive assessment of a resident, the facility must ensure that—

(i) A resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual’s clinical condition demonstrates that they were unavoidable; and

(ii) A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing.

Pressure Sore Injury to Skin and Underlying Tissue

Picture of Pressure Sore From Healthwise

Picture of Pressure Sore From Healthwise

According to WebMD,pressure sores (bed sores) are an injury to the skin and underlying tissue. They can range from mild reddening of the skin to severe tissue damage-and sometimes infection-that extends into muscle and bone. Pressure sores are described in four stages:

Stage 1 sores are not open wounds. The skin may be painful, but it has no breaks or tears. The skin appears reddened and does not blanch (lose color briefly when you press your finger on it and then remove your finger). In a dark-skinned person, the area may appear to be a different color than the surrounding skin, but it may not look red. Skin temperature is often warmer. And the stage 1 sore can feel either firmer or softer than the area around it.

At stage 2, the skin breaks open, wears away, or forms an ulcer, which is usually tender and painful. The sore expands into deeper layers of the skin. It can look like a scrape (abrasion), blister, or a shallow crater in the skin. Sometimes this stage looks like a blister filled with clear fluid. At this stage, some skin may be damaged beyond repair or may die.

During stage 3, the sore gets worse and extends into the tissue beneath the skin, forming a small crater. Fat may show in the sore, but not muscle, tendon, or bone.

At stage 4, the pressure sore is very deep, reaching into muscle and bone and causing extensive damage. Damage to deeper tissues, tendons, and joints may occur.

Additional Information on Pressure Sore Injury

Also see my other blogs on this topic:

Bedsore Stages

Pressure Injury Stages

Pressure Injuries

Pressure Sore Injury Neglect Attorney

If you have questions about nursing home abuse and neglect contact Kenneth LaBore who has handled dozens of very serious pressure sore and ulcer cases for a free consultation.  There is no fee unless there is a verdict or settlement offer from the wrongdoer.  Mr. LaBore can be reached directly at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

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Bedsore Stages

Written By: Kenneth LaBore | Published On: 3rd February 2017 | Category: Bed Sores and Pressure Ulcers, Failure to Resond to Change in Condition, Nursing Home Abuse and Neglect, Pressure Ulcers | RSS Feed

Wound Care After Bed Sore Stages Injury

Bedsore Stages of Injury

Bedsore stages is the same as the stages of a pressure injury.  There are many different names for bedsores, including the same word split into bed sore, pressure injuries, pressure sores, pressure ulcer and decubitus ulcer all are a way of explaining skin breakdown which and the related wound which is then set into stages.  All of these wounds are considered preventable in most cases with proper care and treatment.

According to the Mayo clinic, bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone. People most at risk of bedsores are those with a medical condition that limits their ability to change positions, requires them to use a wheelchair or confines them to a bed for a long time.
Bedsores can develop quickly and are often difficult to treat. Several things can help prevent some bedsores and help with healing.

Wound Characteristics Determine Bedsore Stages

The stages of the bedsore injuries is determined on the characteristics of the wound.  To determine the stage of a wound the provider needs to examine and measure the wound and chart related characteristics such as size (length x width x depth), as well as, the color of the skin and surrounding area, smell, texture and other specifics needed to analysis the wounds origin and progress towards healing.

According to Wikipedia, pressure ulcers occur due to pressure applied to soft tissue resulting in completely or partially obstructed blood flow to the soft tissue. Shear is also a cause, as it can pull on blood vessels that feed the skin. Pressure ulcers most commonly develop in individuals who are not moving about, such as those being bedridden or confined to a wheelchair. It is widely believed that other factors can influence the tolerance of skin for pressure and shear, thereby increasing the risk of pressure ulcer development. These factors are protein-calorie malnutrition, microclimate (skin wetness caused by sweating or incontinence), diseases that reduce blood flow to the skin, such as arteriosclerosis, or diseases that reduce the sensation in the skin, such as paralysis or neuropathy. The healing of pressure ulcers may be slowed by the age of the person, medical conditions (such as arteriosclerosis, diabetes or infection), smoking or medications such as anti-inflammatory drugs.

Information About Bedsore Stages

According to St.Luke’s Health System, the stages of pressure sores bedsores is as follows:

Stage 1

The unbroken skin is red and nonblanchable. Note: It may be difficult to determine blanching in darker skin tones. The affected area may differ in color from the surrounding skin.

  • Goal: Prevent further progression of the injury and support blood flow.
  • Implement treatment plan for (Suspected) Deep Tissue Injury.
  • Cleanse and lightly moisturize the skin. Note: Never massage the affected area. This can cause further damage to tissue. Allow the moisturizer to dry before placing any additional pressure on the area.
    Apply protective dressing, if indicated.
  • Evaluate nutritional intake

Stage 2

Partial-thickness skin loss has occurred and the wound bed is red-pink in color. Slough is not present, but a broken or intact serum-filled blister may be evident.

  • Goal: Prevent full-thickness injury and continue to promote healing.
  • Implement treatment plan for previous stages.
  • Apply dressing to keep wound bed moist and promote healing.
  • Protect fragile skin from adhesives.
  • Reevaluate nutritional intake.

Stage 3

Full-thickness skin loss has occurred. Slough may be present. Subcutaneous fat may be visible, but bone, tendon, or muscle are not. Undermining or tunneling may also be present.

  • Goal: Maintain a clean, moist wound bed to prevent infection and promote new tissue growth (granulation).
  • Implement treatment plans for previous stages.
  • Remove dead tissue (debridement), if needed.
  • Absorb drainage.
  • Fill the injury cavity with appropriate dressing.
  • Evaluate the need for nutritional consultation.

Stage 4

Full-thickness skin loss has occurred. Bone, tendon, or muscle is exposed. Slough or eschar may be present, but the base of the wound can be seen. Undermining and tunneling are often present.

  • Goal: Reduce drainage, remove dead tissue, and establish an environment for new tissue growth.
  • Implement treatment plans for previous stages.
  • Report bone involvement.
  • Treat infection with antibiotics, if indicated.
  • Discuss with the healthcare provider whether surgery is needed.

Unstageable

Full-thickness skin loss has occurred. Slough or eschar covers the wound base. The wound depth cannot be determined because of the slough or eschar.

  • Goal: Determine stage, provide moist environment, and prevent further breakdown.
  • Debride the wound. Do not debride the heel unless signs of infection are present.
  • Reassess injury stage once base is visible.
  • Manage pain of injury.
  • Assess for infection.
  • Discuss pressure injury with the healthcare provider.

For more information see pressures injury stages

Worsening Bedsore Stages Neglect Attorney

If you have questions about bedsore injuries nursing home abuse and neglect contact Kenneth LaBore for a free consultation.  There is no fee unless there is a verdict or settlement offer from the wrongdoer.  Mr. LaBore has handled dozens of bed sore and pressure injury cases and can be reached directly at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

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Pressure Injury Stages

Written By: Kenneth LaBore | Published On: 3rd February 2017 | Category: Bed Sores and Pressure Ulcers, Nursing Home Abuse and Neglect, Pressure Ulcers | RSS Feed
Health-skin-Non-Caucasian, Pressure Injury from NPUAP

Health-skin-Non-Caucasian, Pressure Injury from NPUAP

Pressure Injury Stages Have Many Names

There are names for skin breakdown and deterioration leading to need for pressure injury stages.  Pressure injuries are commonly referred to as “bedsores” sometimes spelled “bed sores” they are medically called decubitus ulcers and as know by many as pressure sores.  No matter the name used these sores are injuries due to excessive amounts of pressure for long periods of time in most cases.  The sores and ulcers occur on pressure points of the body such as the back of the head, shoulders, rear-end and coccyx, and bottom of heals.

Preventable Pressure Injury Stages

According to federal regulations a person who enters a nursing home without a pressure sore should receive proper care and treatment including turning and reposition, proper hydration, nutrition, and hygiene which should prevent ulcers.   The combination of not being turned as you sit in your urine or feces, on already dirty sheets without enough fluids and protein in your body to fight infections heal leads to the perfect situation for large festering and infected sores.  I have seen many cases of sores down to the bone or feel that need amputation after long periods of delay and neglect from care facilities.

Assessment Needed to Determine Pressure Injury Stages

There are sophisticated ways to assess residents of nursing homes and other elder care providers to look specifically for risks including falling, wandering due to confusion, needs assistance with eating and other risks, including skin condition and aggravators for the potential of developing sores.    Interventions should be taken eliminate hazards and risks as much as practicable, including specialized mattresses that reduce occurrences of pressure ulcers, nutritional supplements. medical equipment such as foam splints and boots to help relieve pressure.

One a sore begins it needs to be carefully charted on the characteristics of the wound and the skin surrounding it.  The caregiver and nursing staff needs to look for skin changes from normal skin to open sores and wounds.  Charting needs to include the size in millimeters and centimeters, length x width, x depth.  The color, skin turgor, and other characteristics of the areas surrounding the wound must also be documented.  The goal is to have each aide and caregiver that sees the wound(s) document the status of the wound at that moment in time so a chart or graph can be made to analysis the condition of the wound and determine is it getting worse or better.

NPUAP – Pressure Injury Stages

Ulcers and sores from pressure injury has Stages 1 to 4 and another for wounds that are considered “unstageable” due to dark hardened skin that is over the wound, often necrotic and considered very serious as is the later Stage 3 and 4 sores.  According to the Nation Pressure Ulcer Advisory Panel, NPUAP, an organization focused on the education and research of pressure sores and ulcers who outline the stages of the wounds, Stage 1 is a early wound with a reddened area and Stage 4 is through all the layers of skin and muscle and often bone is revealed.

Pressure Injury Stages Attorney

If you have questions about pressure injury sores or nursing home abuse and neglect contact Kenneth LaBore for a free consultation.  There is no fee unless there is a verdict or settlement offer from the wrongdoer.  Mr. LaBore can be reached directly at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

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Nursing Home Bedsore Lawyer

Written By: Kenneth LaBore | Published On: 31st January 2017 | Category: Inadequate Staffing/Training, Nursing Home Abuse and Neglect, Pressure Ulcers, Wound Care | RSS Feed

Minnesota Nursing Home Bedsore Lawyer

Minnesota Nursing Home Bedsore Lawyer

Minnesota Nursing Home Bedsore Lawyer

Elder care nursing home bedsore lawyer cases usually involve a pressure sore or ulcer also known as bedsore which started or worsened due to a lack of care.  Disabled residents require assistance with many activities of daily living including in many situations turning and repositioning themselves in bed.  Many pressure sores can be prevented or diminished if there is pressure relief from areas likely to develop wounds such as the back, rear-end/coccyx, and heels.

Often times pressure sores and ulcers occur due to a lack of well trained staff, particularly nursing aides.  According to federal regulations, the facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility’s resident population in accordance with the facility assessment required at §483.70(e).

(a) Sufficient staff. (1) The facility must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans.

Federal and State Regulations Summary From Nursing Home Bedsore Lawyer

Federal regulations mandate that based on the comprehensive assessment of a resident, the facility must ensure that—

(i) A resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual’s clinical condition demonstrates that they were unavoidable; and

(ii) A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing.

Minnesota regulation in Statute 144.7065,requires reporting [by the facility to the Commissioner of the Department of Health] of Stage 3 or 4 or Unstageable ulcers acquired after admission to a facility, excluding progression from Stage 2 to Stage 3 if Stage 2 was recognized upon admission.

Nursing Home Bedsore Lawyer Kenneth LaBore

If you have questions about nursing home abuse and neglect and want accountability for preventable bed sores contact Kenneth LaBore for a free consultation.  There is no fee unless there is a verdict or settlement offer from the wrongdoer.  Mr. LaBore can be reached directly at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

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Nursing Home Bed Sore Lawyer

Written By: Kenneth LaBore | Published On: 31st January 2017 | Category: Bed Sores and Pressure Ulcers, Failure to Resond to Change in Condition, Nursing Home Abuse and Neglect, Pressure Ulcers | RSS Feed
Minnesota Nursing Home Bedsore Lawyer

Minnesota Nursing Home Bedsore Lawyer

Minnesota Nursing Home Bed Sore Lawyer

Elder neglect and abuse is preventable as a nursing home bed sore lawyer I frequently see wounds with infection, deep sores, some to the bone and requiring surgery including amputations of feet and lower legs.  Bed sore are really sores that people who are usually limited in mobility receive due to long periods of time in bed and without activity.  Bed sores are usually preventable if a person receives sufficient foods and water, and regular movement of their body and limbs.  Depending on the person they should have a minimum of turning and repositioning every two hours.

Federal regulations mandate that nursing homes must assess resident risks and provide proper care and support that if a person enters a facility without a pressure sore they should not develop one.  Also if a person has a pressure ulcer they receive the proper care, including wound care from an outside provider to ensure that the wound does not get worse.

Minnesota regulation in Statute 144.7065,requires reporting [by the facility to the Commissioner of the Department of Health] of Stage 3 or 4 or Unstageable ulcers acquired after admission to a facility, excluding progression from Stage 2 to Stage 3 if Stage 2 was recognized upon admission.

Rural Minnesota Nursing Home Bed Sore Lawyer

Attorney Kenneth LaBore handles bed sore cases throughout the state of Minnesota and is willing to travel to clients for meeting and hearings in their local county whenever possible.   Bed sore cases are also medical malpractice claims and require expert witness support under Minnesota Statute 145.682.  If the wound worsens to the point of infection sepsis and death then they are also wrongful death cases, which in Minnesota has limited damage jury instructions and expert witness testimony or other evidence must be developed.

There are several stages of pressure bed sores ranging from a Stage 1 reddened area to Stage 4, and Unstageable which are ulcer sores through the layers of skin and flesh and muscle to the bone.  These sores occur most frequently on areas of the body that support pressure when in the bed, including, the shoulders, coccyx, buttocks and heels.

Nursing Home Bed Sore Lawyer Kenneth LaBore

If you have questions about nursing home abuse and neglect and want accountability for preventable bed sores contact Kenneth LaBore for a free consultation.  There is no fee unless there is a verdict or settlement offer from the wrongdoer.  Mr. LaBore can be reached directly at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

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Chris Jensen Health and Rehab Center on CMS Special Focus Facility List Due to High Number of Deficiencies in Quality of Care

Written By: Kenneth LaBore | Published On: 7th January 2017 | Category: Facilities - Nursing Homes, Inadequate Staffing/Training, Pressure Ulcers | RSS Feed
Chris Jensen Health and Rehabilitation Center is Placed on Medicare Special Focus Facility Initiative List

Chris Jensen Health and Rehabilitation Center is Placed on Medicare Special Focus Facility Initiative List

Information About Chris Jensen Health and Rehabilitation Center

Name: CHRIS JENSEN HLTH & REHAB CTR
Address: 2501 RICE LAKE ROAD
DULUTH,  MN  55811
Phone: 218-625-6400   Fax: 218-625-6452
Administrator: MS. AMY PORTER
Minnesota Licensed Bed Capacity: (Nursing Home Beds = 170)
Federally Certified Beds: (Dual Medicare/Medicaid Skilled Nursing and Nursing Facility Beds = 170)

Chris Jensen Health and Rehab Center Survey Results

Results from a survey dated May 12, 2016, indicated that Chris Jensen Health and Rehabilitation Center in Duluth Minnesota had deficiencies which were severe enough to place them on dubious list of special focus facility list of nursing homes with high numbers of serious deficiencies.

On April 7, 2016, the Minnesota Department of Health completed a Post Certification Revisit (PCR) and on April 5, 2016, the Minnesota Department of Public Safety completed a PCR to verify that the facility had achieved and maintained compliance with federal certification deficiencies issued pursuant to an extended survey, completed on February 10, 2016. The MDH presumed, based on their plan of correction, that the facility had corrected these deficiencies as of March 29, 2016. Based the visit, it was determined that your Chris Jensen Health and Rehabilitation Center  has not obtained substantial compliance with the deficiencies issued pursuant to our extended survey, completed on February 10, 2016. The deficiencies not corrected are as follows:

FTag 282, F 282, 42 CFR 483.20(k)(3)(ii) Services By Qualified Persons/per Care Plan

FTag 314, F 314 , 42 CFR 483.25(c) Treatment/Services To Prevent/heal Pressure Sores

The most serious deficiencies in the facility  were found to be isolated deficiencies that constituted actual harm that was not immediate jeopardy (Level G), as evidenced by the attached CMS-2567, whereby corrections were required.

As a result of the revisit findings, the Category 1 remedy of state monitoring remained in effect.

In addition, this Department recommended to the CMS Region V Office the following actions related to the imposed remedies in their letter of March 7, 2016:

Discretionary denial of payment for all Medicare and Medicaid admissions effective April 10, 2016, remain in effect.

Click here for the rest of the May 12, 2016 survey.

For more information from the Minnesota Department of Health, inspection surveys and reports, website, which usually has the most recent survey and the one taken before that.

To speak with an Attorney Kenneth LaBore concerning elder abuse or neglect or related injuries call his direct number 612-743-9048 or by email to KLaBore@MNnursinghomeneglect.com.

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Bethany Residence Cited with Neglect After Resident Suffers Wounds

Written By: Kenneth LaBore | Published On: 4th August 2016 | Category: Pressure Ulcers | RSS Feed
Wound Care Issues at Bethany Residence and Rehab in Minneapolis

Wound Care Issues at Bethany Residence and Rehab in Minneapolis

Bethany Residence in Minneapolis Alleged Neglect Wound Care

In a report dated August 1, 2016, the Minnesota Department of Health alleged that a resident at Bethany Residence was neglect when staff failed to properly monitor and follow physician’s orders for caring of the resident’s wound.  The resident is currently hospitalized for treatment of the wound.

Finding of Neglect Against Bethany Residence

Based on the preponderance of the evidence neglect did occur when the staff failed to follow a physician’s order for wound care.  The staff did not complete the resident’s wound care for four days.  The would became infected and the resident was hospitalized as a result of the infection.

The resident had a diagnoses including venous insufficiency, and chronic stasis ulcer on the right ankle.  The resident had lived at the facility for several years.  The physician’s order for care to the ulcer on the resident’s ankle included daily application of Santyl (a medicated ointment) and to cover the wound with adhesive foam.  A nurse did not change the dressing on 8/10/2015, 8/11/2015, and on August 14, 2015 another nurse caring for the wound observed a foul odor, the skin was swollen and pink, and insects were observed on the wound.  The resident was immediately sent to the hospital for care of the wound, the wound improved, and the resident returned to the facility.

The nurse that had not changed the dressing was interviewed and said she did not change the dressing and though the order was to check that the dressing was in place instead of changing the dressing.  When the error was discovered, the facility re-educated the nurse.

The physician, a wound care physician specialist, was interviewed, he noted that the resident’s wound was chronic and had been slow to heal.  He stated that the error of not changing the dressing for 3 days would have been significant in developing an infection.

For more information from the Minnesota Department of Health, Office of Health Facility Complaints concerning nursing homes, assisted living and other elder care providers view resolved complaints at the MDH website.

If you have concerns about medication errors, improper use of medical equipment, falls or any other form of elder abuse or neglect contact Minnesota Elder Abuse Attorney Kenneth LaBore at 612-743-9048 or toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

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