CAN YOU Recognize Errors And Inaccurate Documentation To Support Your Wound Care Case? Let Our Nurse Experts Help…
Category: Personal Injury
Author: Georgina Tyburski
Posted: Friday - September 25, 2015
Advances in wound care have been significant over the past 20 years. However inaccurate wound care documentation continues to be prevalent in acute care facilities, long term care facilities and home care agencies throughout the healthcare continuum.
Standards for wound care practice are derived from several agencies including the Agency for Healthcare Research and Quality (AHRQ), the American Nurses Association (ANA) Standards of Clinical Nursing Practice, The National Pressure Ulcer Advisory Panel (NPUAP), the European Pressure Ulcer Advisory Panel (EPUAP), The Wound Ostomy Continence Nurses Society (WOCN), the Centers for Medicare & Medicaid Services (CMS) as well as individual state nurse practice acts. Negligence is considered a form of malpractice or “conduct that falls below the professional standard of due care.”It is also considered a “standard minimum of special knowledge and ability.”
The medical record, a legal document, should identify all patient care, including treatment decisions. It is the primary method of communication among the members of the patient’s healthcare team. According to the WOCN standards of care:
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The patient should be holistically addressed, assessing skin risk (specifically pressure ulcers) potential using a valid tool. IE: Braden Risk Assessment Scale or the Norton Scale.
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Nutritional status should be addressed.
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The need for specialty devices such support surfaces.
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Referrals to another medical specialty practice such a wound care specialist, podiatrist and nutritionist.
Most facilities have forms, policies and procedures to address these standards however are often not followed or documented. One of the most significant errors in wound care documentation is inaccurately assessing the type of wound a patient has especially on the lower extremities. A patient that has wounds on the hips, sacrum and heels are most often pressure ulcers. Pressure ulcers can occur on any part of the body that has pressure for example ears from oxygen tubing or any where a medical device may be in place. The inaccuracies and errors occur when nurses assess vascular ulcers either venous stasis or arterial wounds as pressure ulcers. Why is this significant? Vascular ulcers and arterial ulcers demand different treatment options based on standards of care. A vascular ulcer assessed as a pressure ulcer may not heal with pressure relief and topical wound care treatment. What are the nursing standards with regards to vascular ulcers?
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Assess the wound for size, drainage, pain, edema, color, odor, presence of slough or necrosis, depth of the tissue, surrounding peri-wound, edges- are they fixed or is there undermining. Assess hair distribution on the lower legs, toenails, sensation, and skin temperature. Evaluate co-morbidities.
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Develop a differential diagnosis. Request a referral for vascular evaluation. Vascular pathology is linked with the majority of leg ulcers. About 70 % of leg ulcers have a venous etiology. Approximately 20% -25% of vascular ulcers are due to arterial insufficiency and some of these have mixed vascular etiology.
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Request a referral to a wound care specialist for treatment options.
After the nurse assessment and while waiting for the vascular evaluation the nurse should at a minimum cleanse the wound, maintain a moist wound healing environment. If there is a large amount of drainage ensure that drainage is absorbed with a dressing so maceration does not occur. If the wound is dry often with arterial wounds, add moisture such as wound gel. Cover the wound with a non-adherent dressing and wrap with kling gauze. Do not use tape directly on the skin for leg ulcers.
For venous insufficiency with pitting and or weeping edema the treatment standard is compression bandaging after ruling out ischemia, infection, cellulitis or DVT.
References:
European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Pressure
Ulcer treatment: Quick Reference Guide. Washington DC: National Pressure Ulcer
Advisory Panel; 2009.
Kelechi, T. J. & Johnson, J.J. (2012). Guidelines for the management of wounds in patients with
Lower- extremity venous disease. Journal of WOCN, 39 (6), 598-606.
Sussmman, C. & Bates-Jensen, B. (2012). Assessment of the patient, skin, and wound. Wound
care: A collaborative practice manual for health professionals(4th ed.) (pp. 53-109).
Baltimore, MD: Lippincott Williams & Wilkins
