facility acquired pressure ulcers

kids · Jun 16, 2010

I have sat on my hospital's skin care committee for years and I am very well aware of the new research on unavoidable pressure ulcers. That applies to people with horrible vascular disease/severe blood flow problems, horrible nutrition, possibly pressor use. None of these things were the case.

I agree that what you listed are the typical factors that can lead to "unavoidable" pressure ulcers.

Sometimes pressure ulcers do 'just happen' despite perfect or near perfect efforts at prevention.

I am a 46 year old and spend the majority of my waking hours in a wheel chair due to a spinal cord injury. I have excellent nutrition, am within IBW, have a good amount of sensation and have no other co morbidities. I have chronic and recurrent stage II ulcers on a trocanter and my sacrum despite very frequent pressure relief and a top of the line cushion and a well fitting chair. It's only through periods of bed rest that I'm able to get them healed. Everything that can be done to reduce pressure from the outside is being done, it's the pressure from the inside that can't realistically be prevented.

achot chavi · Jun 16, 2010

if they have worsened so quickly has anyone done an x-ray to rule out osteomylitis?

Check out:

Decubitus ulcers: when to suspect osteomyelitis. [Geriatrics. 1987] - PubMed result

You definitely have reason to check out where the pressure sores originated- do you have the discharge summary from the hospital?

What treatments other than topical are you exploring? WHat is her albumin level? is she turned and positioned properly q2h? what mattress is she lying on etc. Does she suffer from pain from the wound? Could it be infected?,.,,

I care less about blame and more about getting proper and effective treatment.

However, you could always sit with the medical and nursing directions.

Good Luck and hope you can report that she is all healed soon!

CoffeeRTC, BSN, RN · Jun 16, 2010

I think I get what the OP was saying about $$$. Thru and thru, I'm frugal. Sorry, but it is true. Not knowing about the payment source of the OPs Gramma, if I was paying out of pocket and had to pay for an avoidable expense like this...I would be a bit miffed. Pressure ulcers are very, very expensive. Aren't insurance companies refusing to pay for hospital aquired infections?

achot chavi · Jun 16, 2010

I think I get what the OP was saying about $$$. Thru and thru, I'm frugal. Sorry, but it is true. Not knowing about the payment source of the OPs Gramma, if I was paying out of pocket and had to pay for an avoidable expense like this...I would be a bit miffed. Pressure ulcers are very, very expensive. Aren't insurance companies refusing to pay for hospital aquired infections?

totally understand and believe me- if I thought that negligent care was the cause of such a thing for a family member or friend of mine, I would be kicking and screaming. If she thinks that suing the appropriate party will help, then I understand. But she has to get her ducks in line first. Is she the POA?

CNL2B · Jun 16, 2010

I think I get what the OP was saying about $$$. Thru and thru, I'm frugal. Sorry, but it is true. Not knowing about the payment source of the OPs Gramma, if I was paying out of pocket and had to pay for an avoidable expense like this...I would be a bit miffed. Pressure ulcers are very, very expensive. Aren't insurance companies refusing to pay for hospital aquired infections?

Yes, they are, to the best of my knowledge. Medicare as well stopped paying for them about 5 years ago, to my understanding. Patient is Medicare and Medicaid dependent, and apparently according to my MIL they are paying for it (at least, they are not getting billed for any wound care.) It makes me wonder how they are documenting or billing for these wounds to get them covered.

The whole situation is just very fishy to me. I think it's about 50/50 -- partially bad care, partially risk factor involvement with the ulcer development.

Heard the situation of the 46 YO W/C bound individual a couple posts back -- I get that, certainly long term W/C dependence has risks. I am trusting that you have been W/C bound much longer than 18 months like grandma though.

CoffeeRTC, BSN, RN · Jun 16, 2010

It really doesn't take that long for a pressure ulcer to develop...I know you know this, but it can be hrs, days and weeks.

Comparing 18 months to the years that PP has been in a WC doesn't compare.

That pressure ulcer started the minute she became imobile and her system was compromised.

SuesquatchRN, BSN, RN · Jun 16, 2010

Yes, they are, to the best of my knowledge. Medicare as well stopped paying for them about 5 years ago, to my understanding. Patient is Medicare and Medicaid dependent, and apparently according to my MIL they are paying for it (at least, they are not getting billed for any wound care.) It makes me wonder how they are documenting or billing for these wounds to get them covered.

It did not stop paying for them in LTC. When a resident is accepted under Medicaid the monthly payment is accepted for everything provided within the facility.

kids · Jun 16, 2010

Heard the situation of the 46 YO W/C bound individual a couple posts back -- I get that, certainly long term W/C dependence has risks. I am trusting that you have been W/C bound much longer than 18 months like grandma though.

Interesting that the assumption is that I've been in a wc for years.

I haven't really, I started using it at work for speed and distance only about 3 years ago. Use increased drastically less than a year ago and it's only in the the last couple of months I've had to switch to using in nearly full time. I'm still ambulatory at home as I can wall walk around or small house.

Schmoo1022 · Jun 17, 2010

Hi, I'm a hospital nurse.
My grandmother in law is W/C bound after a bout of Guillian-Barre about 18 months back. After it was determined that she was never going to walk again she was placed in a local LTC -- she is a paraplegic, but unable to do her own transfers due to her age and strength, so she is a hoyer lift. She has pressure ulcers to the bone on her backside (this is per reliable report, haven't actually seen them). She schleps several times a week to a hospital wound care center for dressing changes, etc.
My concern is that these were definitely facility acquired -- not sure if they started back in the hospital or at the LTC but they definitely worsened significantly at the LTC. The time frame I think is despicable. To have something this horrible after not having been a para or quad for a lifetime (who as everyone knows, are at very high risk) --> this bad in 18 months? Really?
Who pays for this? Is she getting billed for wound care/transportation?
What about how this has impacted her quality of life?
How does one go about reporting this or receiving restitution? Can you go to the state?
What do all of you that are facility DONs/ADONs have to say about something like that?

I was wondering if anyone contacted your family when the wound was first noticed? Our facility notifies the family ASAP when we have a wound. Most of the time, even when you know a patient is at risk and all the interventions are in place, a wound happens.

debRN0417 · Jun 24, 2010

Why not ask the State Agency to do an investigation? I mean, many complaints are called in regarding care issues. If you call and give them specifics, like you have done here, there would be valuable information that the State could use in their investigation to try to help answer your questions. Anyone can call in a complaint. If you feel this is wrong, and obviously you are very close to the situation and know many details, and also very well educated, then have an investigation done. It certainly cannot hurt. Lawsuit or not, if its wrong, its wrong, although mistakes do happen, there should be measures in place to prevent harm to any resident.

noc4senuf · Jun 25, 2010

If she is Medicare and Medicaid, the nI am thinking she probably also has Med B and the facility is having them pay for the supplies.