Deviation in the Standard of Care for Patients with Decreased Mobility Resulting in Exacerbation of Existing Decubitus Ulcers or the Development of New Ulcers (Pressure or Bed Sores, Pressure Ulcers)

Evaluate breaches in the standard of care to determine if there was a Deviation in the Standard of Care for Patients with Decreased Mobility Resulting in Exacerbation of Existing Decubitus Ulcers or the Development of New Ulcers (Pressure or Bed Sores, Pressure Ulcers)

Answer the following questions to find out if the standard of care was followed for your case.

  • Was a thorough physical evaluation performed?
    Yes
    No
    Answer unknown
    Why is this important?
    The patient needs to be examined thoroughly at the time of admission for any existing signs of skin breakdown, any existing reddened area, any open wounds and any existing ulcers.
    (2006) 90 EMEDCN 5 925-944

  • Was either a Norton or a Braden scale used to assess the patient’s risk? Why is this important?
    Answer this question
    After the initial assessment, the risk for pressure ulcers needs to be assessed by either a Norton scale or a Braden scale.
    (2010) 28 ECLDER 5 527-532

  • Which of the following scores were documented? Why is this important?
    Answer this question
    The Braden Scale is the scale most frequently used in research, and is recommended by the American Agency for Health Care Research and Quality for predicting pressure ulcer risk.
    (2010) 28 ECLDER 5 527

  • How frequently was the patient turned and repositioned? Why is this important?
    Answer this question
    A bedridden patient needs to be turned at least every 2 hours. This frequency, however, can vary, depending on the risk status of the patient and the type of mattress used. All bedridden patients need to be provided a pressure-relieving mattress in addition to being frequently repositioned.
    (1998) 38 JNLAAD 4 517-538

  • Which of the following incontinence issues did the patient suffer from? Why is this important?
    Answer this question
    Urinary or fecal incontinence are important factors to consider in the treatment of decubitus ulcers and can delay wound healing.
    (1999) 20 ECLCMD 2 453-467

  • Was the patient's incontinence treated? Why is this important?
    Answer this question
    Interventions to decrease the effects of moisture include skin care, containment and accurate diagnosis of the cause of incontinence, along with associated incontinence management. Containment of stool can be accomplished with the use of diapers and the application of skin barrier ointments.
    (1999) 20 ECLCMD 2 453-467

  • Was a nutritional assessment conducted and documented in the medical chart? Why is this important?
    Answer this question
    Malnutrition leads to reduction in subcutaneous fat and a delay in wound healing. Measures to increase the patient’s protein intake need to be initiated, if deemed necessary based upon the nutritional assessment.
    (1998) 38 JNLAAD 4 517-538

  • Was a dietician consulted? Why is this important?
    Answer this question
    Appropriate nutrition and hydration promote wound healing. An increase in calories and fluids, a high protein diet and an increase in foods rich in vitamins and minerals are recommended. Dietary supplements such as vitamin C and zinc are recommended in these patients.
    (2004) 188 AMJLSU 1S1 9-17

  • Was the patient diabetic? Why is this important?
    Answer this question
    Diabetic patients are at higher risks of development of decubitus ulcers.Therefore the diabetes needs to be controlled medically.For diabetic patients, extra care needs to be implemented to avoid wound development and in the treatment required for existing ones
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  • Did the patient participate in physical therapy? Why is this important?
    Answer this question
    A physical therapist can recommend an appropriate exercise program that improves circulation and builds up vital muscle tissue, thereby aiding in the prevention of decubitus ulcers.
    (2004) 188 AMJLSU 1S1 9-17

  • Did the patient have any decubitus ulcers upon admission? Why is this important?
    Answer this question
    Early recognition and intervention are vital to successful treatment of pressure ulcers. Every patient at risk needs to have the skin around the trochanteric, sacral, ischial, and heel areas examined upon admission. Any break in the skin needs to be documented immediately and a treatment plan initiated directly.
    (2004) 188 AMJLSU 1S1 9

  • What was the staging of the decubitus ulcer? Why is this important?
    Answer this question
    The higher the stage the more involved and prolonged the healing time.
    (2004) 188 AMJLSU 1S1 9-17

  • Which of the following treatment measures were implemented? Why is this important?
    Answer this question
    An occlusive dressing promotes the healing of a decubitus ulcer by keeping the wound moist, creating a barrier against infection and keeping the surrounding skin dry. A variety of dressings are available, including films, gauzes, gels, foams and various treated coverings.
    (2006) 7 JLAMDA 1 46-59

  • Were steps taken to relieve pressure from the skin and surrounding tissues? Why is this important?
    Answer this question
    Special cushions, pads, mattresses and beds can help a person lie in an appropriate position, relieve pressure on an existing sore and protect vulnerable skin from damage. A variety of foam, air-filled or water-filled devices provide cushion for those sitting in wheelchairs.
    (2004) 188 AMJLSU 1S1 9-17

  • Were regular assessments of the decubitus ulcers conducted and documented? Why is this important?
    Answer this question
    Taking measurements of the patient's ulcer and documenting the findings is necessary so that comparisons can be made and progress can be documented.
    (2004) 188 AMJLSU 1S1 9-17

  • Which of the following complications did the patient experience? Why is this important?
    Answer this question
    Wound infections impair healing. The possible presence of an infection needs to be considered even if systemic signs, such as fever and leukocytosis, are absent.
    (2006) 7 JLAMDA 1 46-59

  • Did the patient’s wound heal uneventfully without any complications? Why is this important?
    Answer this question
    Aggressive treatment of decubitus ulcers may not be in the best interests of patients who are terminally ill. Conservative medical care and maintaining patient comfort is the goal of treatment in this patient population, as aggressive, invasive measures may not improve their quality of life.
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  • Was the patient provided with pain management? Why is this important?
    Answer this question
    Pain management is essential for all patients with decubitus ulcers regardless of the ulcer’s staging. Analgesics may be required to relieve the patient’s discomfort.
    (2000) 16 ECLGMD 4 783-803

  • Was the patient referred to a specialist? Why is this important?
    Answer this question
    Urgent medical attention is required for patients with pressure ulcers who show clinical signs of sepsis
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