Medical-Legal Implications of Iatrogenic Injuries in Geriatric Care Facilities

Transcription

1 Medical-Legal Implications of Iatrogenic Injuries in Geriatric Care Facilities Aimée D. Garcia, MD, CWS, FACCWS, FAPWCA Associate Professor, Department of Medicine Geriatrics Section, Baylor College of Medicine Medical Director, Wound Clinic and Consult Service Michael E. DeBakey VA Medical Center Insert academic affiliation, practice or hospital logo(s) of preference here. Product and/or sponsor logos not permitted, per CME guidelines.

2 Disclosures Stockholder: none Grant/Research Support: none Medical/Scientific Boards: Insert Company Name Insert Company Name Speaker s Bureau: 3M Medline Honorarium: 3M Medline Organogenesis Consultant: Organogenesis

3 Objectives Outline the epidemiology of chronic wounds in the elderly Discuss common legal issues related to long term care

4 Epidemiology Voss AC, Bender SA, Ferguson ML, et al. Long-term care liability for pressure ulcers. J Am Geriatric Soc. 2005;53: The Aging Imperative No impact on frailty Litigation 17,000 lawsuits filed annually on pressure ulcer cases alone Highest payout-$312m in a single case

5 Common skin conditions in the elderly Pressure Ulcers/Injuries Venous stasis ulcer Arterial wound Skin tears

6 Pressure Ulcer/Injuries First question: Is this a pressure ulcer/injury MASD Skin tears Trauma Infection Second question: Was it avoidable/unavoidable? Were all elements of prevention put in place? Is this SCALE or Kennedy terminal ulcer? Are patient preferences/choices making skin breakdown unavoidable? Has proper documentation been done?

7 Venous Stasis Ulcer Has appropriate work up been done? ABI s Echo Is the patient a candidate for compression therapy? What type of compression is most appropriate for the patient?

8 Arterial ulcers Has a vascular work up been done and documented? Is the patient a candidate for surgical intervention? Is the patient a candidate for medical intervention? Pentoxifylline Cilostazole

9 Skin Tears Are preventive strategies being utilized to prevent further skin breakdown? Is tape being used directly on the skin? If ongoing, are sleeves or padding being used to minimize the risk?

10 4 Prong Test for Defense Evaluate risk factors Implement interventions (i.e. turning and repositioning, pressure relieving devices, and nutritional supplements, etc.) Monitor the impact of those interventions Revise those interventions, where appropriate.

11 Documentation The C s of documentation: Clear Comprehensive Concise Chronological Complete Coder friendly Camera? Communication** With team With family

12 Wound Evaluation, Assessment and Documentation

13 Wound Assessment History and physical Co-morbidities how wound happened/appeared/developed previous interventions medications nutritional status pain psychosocial issues Risk Assessment- Braden scale or Norton scale

14 Wound Assessment Location on the body Standard Assessment is based on the premise that the wound is rectangular Length x Width x Depth in centimeters Undermining or tunneling? Hess CT. The art of skin and wound care documentation. Adv skin and wound care 2005;18:43-53

15 Wound Dimensions -Depth Use applicator to find deepest part of wound Grasp applicator stick at skin level, remove and measure depth

16 Wound Assessment Undermining Clock measurement Measure with cotton tipped applicator ex: 4.2 cms from 12 to 6 o clock Wound bed Red, yellow, black red is % of granulation yellow is % of slough black is % of eschar Level and type of drainage Odor

17 Undermining

18 Tunneling/Sinus Tracts

19 Wound Documentation When should we assess? Upon admission or first notation of any compromise in the skin Skin should be assessed during routine carebathing, perineal care, etc If a wound is present, assess at each dressing change When should we document? Total skin exam should be documented on admission, and if there is any evidence of compromised skin, formal assessment once a week

20 Wound Documentation Why is it important? Documentation serves as a tool for communication for members of the healthcare team Reimbursement for hospital, new F-TAG Litigation!! The best way to prevent litigation is to have good documentation of vigilance and care

21 Summary Thank you! Questions?

22 Medical-Legal Implications of Iatrogenic Injuries in Geriatric Care Facilities Aimée D. Garcia, MD, CWS, FACCWS, FAPWCA Associate Professor, Department of Medicine Geriatrics Section, Baylor College of Medicine Medical Director, Wound Clinic and Consult Service Michael E. DeBakey VA Medical Center Insert academic affiliation, practice or hospital logo(s) of preference here. Product and/or sponsor logos not permitted, per CME guidelines.