Posts Tagged ‘Bed Sores/Pressure Ulcers’

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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

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.

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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.

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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.

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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

Red Wing Health Center Red Wing Neglect Substantiated

Written By: Kenneth LaBore | Published On: 1st March 2017 | Category: Fall Injuries, Financial Exploitation | RSS Feed

Substantiated Allegation of Neglect at Red Wing Health Center After Resident Suffers From Unstageable Pressure Ulcers Stage III/IV Pressure Sores While at the Facility

Red Wing Health Center Resident Suffers from Pressure Sores

In a report dated January 23, 2017 the Minnesota Department of Health alleged that a resident at Red Wing Health Center in Red Wing was neglected when s/he developed several unstageable pressure ulcers and Stage III/IV pressure ulcers while s/he was at the facility.

Red Wing Health Center Substantiated Neglect Due to Pressure Ulcers

Based on a preponderance of the evidence, neglect occurred when facility staff failed to implement a resident’s designated care plan interventions to heal pressure ulcers and prevent new ulcers from developing. Although facility nurses were aware that the resident was resisting the care plan interventions, facility nurses failed to address any alternative approaches for effective wound management. The resident developed nine new pressure ulcers in four months, including several that became infected and exhibited serious characteristics such as tunneling with depth, exposing muscle and bone. The resident was hospitalized twice in four months with sepsis from wound infections.

The resident was admitted to the facility from another long-term care facility at the end of April 2016. At the time of admission, the resident had two pressure ulcers, an unstageable pressure ulcer on the sacrum (2.7 cm x 1.5 cm x .4 cm) and a Stage II pressure ulcer on the right heel (1.8 cm x 1 cm). The resident has complete paraplegia and multiple sclerosis. The resident is unable to move his/her legs and has limited use of his/her arms. The resident can use an electric wheelchair independently which the resident propels with a joy stick. The resident is alert and oriented.

The resident had an alternating air mattress on his/her bed and a pressure redistributing cushion in the electric wheelchair. Staff were supposed to turn and re-position the resident every two hours and offload the resident hourly per the resident’s care plan, but these interventions were not carried out. There was no planned turning or re-positioning schedule for pressure redistribution and staff did not offer to turn or reposition the resident unless the resident requested it. The resident was expected to offload him/herself by reclining the backrest of the wheelchair, but the frequency of offloading was not monitored by staff. The nursing assistant care guides regarding the resident’s daily care tasks were void of any interventions aimed at wound management, including turning, re-positioning, or offloading the resident. Nurses did not provide adequate oversight of the resident’s daily care by nursing assistants or the resident’s daily needs to heal wounds and prevent new wounds from developing.

Although staff stated that the resident consistently refused wound management interventions, there was no evidence that staff evaluated the inadequacy of interventions of assessed the resident’s individualized needs for alternative interventions. At the end of June 2016, the resident was hospitalized with sepsis due to a sacral wound infection. The sacral pressure ulcer had deteriorated to Stage IV with exposed muscle and Stage II pressure ulcer on the right hip (10 cm in diameter), a Stage II pressure ulcer on the left hip (6 cm in diameter), a Stage II pressure ulcer on the left ischium (2 cm x 2 cm), and a Stage II pressure ulcer on the right ischium (2 cm x 2 cm).

After the resident returned to the facility from the hospital, there was no evidence that staff re-evaluated the resident’s care plan interventions to determine modifications necessary for wound management and skin integrity. There was no evidence that staff initiated structured care interventions, including possible behavioral strategies, to promote wound healing and prevent new skin breakdown.

In mid-September 2016, the resident was hospitalized again with sepsis due to wound infections. On hospital admission, the resident had eleven pressure ulcers. Four of eleven pressure ulcers had grossly deteriorated. The sacral pressure ulcer (12 cm x 10 cm) was unstageable with purulent foul drainage and macerated edges. The left hip pressure ulcer was unstageable (9 cm x 7 cm) with purulent foul drainage. The right hip pressure ulcer had deteriorated to Stage IV (12 cm x 12 cm 1.5 cm) with bone felt at the bottom of the wound bed. The right ischium pressure ulcer had deteriorated to Stage IV (6 cm 5 cm 6 cm) with muscle exposed. The resident also had seven additional pressure ulcers, including Stage III pressure ulcer on the left lateral ankle (3.5 cm x 2.0 cm), five pressure ulcers classified as unstageable on the right posterior shoulder (5.0 cm x 4.0 cm), the right heel (2.0 cm x 2.0 cm x 2.5 cm), the left heel (2.2 cm x 1.2 cm), the left lateral foot (1.0 cm x 1.5 cm), the right medical ankle (1.3 cm 0.7 cm), and a Stage I pressure ulcer on the right lateral ankle. The resident was hospitalized for eight days due to the seriousness of the wounds.

After the resident returned to the facility from the hospital, there was no evidence that staff re-evaluated the resident’s care approaches or made any changes in the resident’s daily care routine. At the time of the onsite investigation, staff were not turning, repositioning, or offloading the resident and the Nurse Manager of the resident’s until did not know how many wounds the resident had, what the condition of the resident’s wounds were, or what the care plan interventions were to heal the resident’s wounds and prevent new wounds from developing.

Red Wing Health Center – Report Abuse and Neglect

Click Here For Link To Report Abuse To Adult Protection

Hold Negligent Providers Like Red Wing Health Center Accountable

Attorney Kenneth LaBore has handled many preventable serious and fatal burn injuries, many due to the failure to follow safety policies and procedures related to oxygen use and smoking. Burns can also happen from scalding water, heaters and electric pads and blankets and other ways.

If you have concerns about pressure sore injuries 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

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Physical Abuse by Staff Heritage House of Milaca Minnesota

Heritage House of Milaca Complaint Findings for Exploitation

In a report concluded on January 31, 2011, the Minnesota Department of Health cites Heritage House of Milaca for exploitation by staff.

The allegation is abused based on the following: Employee (A), alleged perpetrator (AP) grabbed Client #1’s wrist causing bruising on Client #1’s hand and wrist.

Substantiated Complaint Against Heritage House of Milaca

According to the National Center on Elder Abuse, elder abuse is a growing problem. While we don’t know all of the details about why abuse occurs or how to stop its spread, we do know that help is available for victims. Concerned people, like you, can spot the warning signs of a possible problem, and make a call for help if an elder is in need of assistance.

•Physical Abuse
•Sexual Abuse
•Emotional or Psychological Abuse
•Neglect
•Abandonment
•Financial or Material Exploitation
•Self-neglect

If you have concerns about financial exploitation 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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Wheelchair Injury Fall Red Wing Health Center Red Wing Minnesota

Red Wing Health Center Cited for Abuse – Exploitation – Drug Diversion

In a report dated February 4, 2016, the Minnesota Department of Health cited Red Wing Health Center alleged that a resident was financially exploited when a staff, alleged perpetrator (AP) took a resident’s pain medication for his/her own personal use.

Based on a preponderance of the evidence financial exploitation did occur when the alleged perpetrator (AP) took 39 oxycodone (a narcotic) tablets from the resident for his/her own personal use over a period of approximately a month.

Red Wing Health Center Red Wing Complaint Findings for Neglect – Falls

In a report concluded on April 26, 2012, the Minnesota Department of Health cites Red Wing Health Center Red Wing for neglect of health care -falls.

The allegation is neglect based on the following: Resident #1 had a fall, with serious injuries, when Employee (J)/Alleged Perpetrator (AP) placed Resident #1 in the wrong wheelchair, which did not have a pressure alarm or self-release seat belt.

If you have concerns about falls, fractures, financial exploitation or any other form of elder abuse or neglect contact Elder Abuse and Neglect Attorney Kenneth LaBore toll free at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

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Nursing Home Injuries

Written By: Kenneth LaBore | Published On: 5th February 2017 | Category: Bed Sores and Pressure Ulcers, Failure to Resond to Change in Condition, Fall Injuries, Hoyer Lift, Medication Drug Error, Nursing Home Abuse and Neglect, Patient Lift, Sexual Abuse, Wrongful Death | RSS Feed

Minnesota Abuse and Neglect Nursing Home Injuries

Minnesota Nursing Home Injuries

There are many ways that residents suffer nursing home injuries, many are falls, being dropped from lifts or injured in transfer, falls from the toilet or in the shower, fall from bed or out of a wheelchair. Since the way that many injuries happen is foreseeable the facility has an obligation to analysis and assess the risks to each resident and take reasonable measures and interventions to protect them from preventable accident situations.

Pursuant to federal and state regulations nursing homes have an obligation to keep their residents safe. They are considered vulnerable adults by legal definition since they are staying in a nursing home facility.

According to 42 CFR 483.25, nursing homes must take efforts to prevent accidents which would include falls, medication errors, or any other way you could be injured such as through the use of oxygen, smoking, scalding burns, urinary tract infections, pressure wounds and others set out in the statute.

Common Types of Nursing Home Injuries

Here are some summaries on various topics related to nursing home falls and fractures, pressure sores and other nursing home injuries:

Patient Lift Injuries

Wrongful Death from Falls

Fractures from Falls

Falls from Wheelchairs

Falls in Bathroom

Falls in Shower

Falls from Bed

Nursing Home Neglect Fractures

Bedsore Stages

Pressure Injury Stages

Pressure Sore Injury

Pressure Injuries

Nursing Home Fall Injuries Lawyer

If you or someone you love is in a skilled nursing facility or nursing home and the victim of abuse or neglect injuries contact Attorney Kenneth LaBore for a free consultation to discuss the fall or injuries and he does not charge a fee unless there is a verdict or settlement offer with the wrongdoer. Call Kenneth LaBore at 612-743-9048 or toll free at 1-888-452-6589 or send an email to KLaBore@MNnursinghomeneglect.com.

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Pressure Sore Stages

Written By: Kenneth LaBore | Published On: 3rd February 2017 | Category: Bed Sores and Pressure Ulcers, Patient Lift | RSS Feed

Pressure Sore Stages NPUAP Stage 5, Deep Tissue Pressure Injury

Pressure Sore Stages

Pressure sores stages are categorized into four key stages depending on their age, size, depth and severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, defines each stage.

According to the Mayo Clinic, for people who use a wheelchair, pressure sores often occur on skin over the following sites:

Tailbone or buttocks
Shoulder blades and spine
Backs of arms and legs where they rest against the chair

For people who are confined to a bed, common sites include the following:

Back or sides of the head
Rim of the ears
Shoulders or shoulder blades
Hip, lower back or tailbone
Heels, ankles and skin behind the knees

Pressure Sore Stages

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.

In stages 3 and 4 there may be little or no pain due to significant tissue damage. Serious complications, such as infection of the bone (osteomyelitis) or blood (sepsis), can occur if pressure sores progress.

Sometimes a pressure sore does not fit into one of these stages. In some cases, a deep pressure sore is suspected but cannot be confirmed. When there isn’t an open wound but the tissues beneath the surface have been damaged, the sore is called a deep tissue injury (DTI). The area of skin may look purple or dark red, or there may be a blood-filled blister. If you or your doctor suspect a pressure sore, the area is treated as though a pressure sore has formed.

There are also pressure sores that are “unstageable,” meaning that the stage is not clear. In these cases, the base of the sore is covered by a thick layer of other tissue and pus that may be yellow, gray, green, brown, or black. The doctor cannot see the base of the sore to determine the stage.

Pressure Sore Stages 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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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

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

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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 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

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

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

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

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 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.

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

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