Facts concerning Decubitus Ulcers, California Regulations, and Nursing Standards of Practice concerning Nursing Homes

Written by Adam Peck Category: Bed Sores March 26th, 2013 5 min read

FACTS REGARDING DECUBITI

Pathophysiology: any force that compresses tissue or causes a shearing motion and friction to the skin can disrupt the skin’s microcirculation. The resulting ischemia leads to inflammation and tissue anoxia followed by cell death, necrosis, and ulceration.
The hip and buttocks region account for 67% of all pressure sores; the sacrum is one of the most common locations.
The Braden Scale is a validated tool used to assess a patient’s risk of developing a pressure ulcer by examining six criteria: sensory perception, moisture, activity, mobility, nutrition and friction and shear. Each category is rated on a point scale, combining for a possible total of 23 points. An adult with a score below 18 is considered to have a HIGH RISK for developing a pressure ulcer.
Decubiti are often fatal and are one of the leading iatrogenic causes of death reported in developed countries, second only to adverse drug reactions. Some complications include sepsis, gangrene, renal failure and amyloidosis.
Any patient who is bedridden or cannot move due to diabetes, circulation problems, incontinence or mental disabilities should be checked for pressure sores everyday

REGULATIONS GOVERNING NURSING HOMES

California Code of Regulations (CCR) Title 22 Social Security Division 5Licensing and Certification of Health Facilities, Home Health Agencies, Clinics and Referral Agencies Chapter 3 Skilled Nursing Facilities pertinent to this case: section 72315 Nursing Service- Patient Care (f) Each patient shall be given care to prevent formation and progression of decubiti, contractures and deformities. Such care shall include:

Changing position of bedfast and chairfast patients with preventative skin care in accordance with the needs of the patient.
Encouraging, assisting and training in self-care and activities of daily living.
Maintaining proper body alignment and joint movement to prevent contractures and deformities.
Using pressure-reducing devices where indicated.
Providing care to maintain clean, dry skin free from feces and urine.
Changing of linens and other items in contact with the patient, as necessary, to maintain a clean, dry skin free from feces and urine.
Carrying out of physician’s orders for treatment of decubitus ulcers. The facility shall notify the physician, when a decubitus ulcer first occurs, as well as when treatment is not effective, and shall document such notification as required in Section 72311(b). Code of Federal Regulations (CFR) Title 42 Public Health Chapter 4 Centers for Medicare & Medicaid Services, Department of Health and Human Services Subchapter G Standards and Certification Part 483 Requirements for States and Long Term Care Facilities pertinent to this case:
- Quality of Care – Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.
- Pressure sores – Based on the comprehensive assessment of a resident, the facility must ensure that:
  1. a resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and
  2. a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.

Nursing Standards of Practice (Standards of Care)

Standards are authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are held accountable.
Federal and state laws, rules and regulation and other professional agencies/organizations help define standards of practice. The American Nursing Association (ANA) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have established nationally recognized standards of care which can hold nurses accountable, regardless of their area or state of practice.
According to standards of care, a licensed nurse shall, in a complete, accurate and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client’s response to that care. Nurses assume a liability risk if they fail to monitor a patient or to recognize changes in a patient’s condition. Failure to recognize the significance of changes or to communicate them clearly and promptly to the attending practitioner could endanger the patient.
Any nurse who does not meet accepted standards of care runs a risk of being found negligent. Standards of care may serve as guidelines when evaluating nursing care for possible negligence.
Society holds nurses and those under their supervision accountable for their actions. The nurse is responsible and accountable for the quality of nursing care given to clients.

The PECK LAW GROUP specializes in personal injury matters relating to Serious and Catastrophic Injury, Nursing Home Abuse and Neglect, Bed Sores, Decubitus Ulcers, and Pressure Sores, Medical Malpractice, Surgery Errors, Traumatic Brain Injury, Birth Injury and Wrongful Death that are determined to be a breach of the standard of care. Our experts and our attorneys have superior knowledge and know-how in handling these type of matters from inception to Trial if need be. You will receive superior representation and, of course, the best possible result based upon our know-how and expertise.

Call us Now. THE PECK LAW GROUP In Southern California at (818) 908-0509; In Northern California at (925) 808-5708; or all across the United States toll-free at (866) 999-9085

– from Steven Peck, Senior Attorney at Peck Law Group

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Written by Adam Peck

Expertise: Personal Injury

Adam J. Peck, ESQ is a principal with Peck Law Group, APC. In 2008, Mr. Adam Peck received his Juris Doctorate from Whittier Law School where he graduated Cum Laude. His practice is primarily dedicated to representing Elders, Dependent Adults, along with their loved ones and family members, who have suffered horrific personal injuries.