A recent case review was conducted to determine the merit of a potential lawsuit involving the development and worsening of a pressure ulcer in a nursing home resident. The resident, who was currently living at home with a stage 4 wound being treated by home health services, had previously been under the care of said nursing home. The review focused on whether the wound developed and worsened due to the facility's lack of care and services.

Initial Assessment:

• The admitting nurse's assessment indicated no skin issues, with all skin intact.

• A Braden Scale for Predicting Pressure Ulcer Risk was completed, noting a score of 12, indicating a high risk for pressure ulcers.

• The facility should have developed skin integrity safety measures in the care plan to address the high risk for skin breakdown.

Baseline Care Plan:

• Interventions included assessing skin during daily care, keeping skin clean and dry, moisturizing skin, and a turning/repositioning program every two hours.

• These interventions were appropriate and aligned with Centers for Medicare and Medicaid Services (CMS) regulatory guidelines.

Comprehensive Care Plan: 

• Same interventions as noted on baseline care plan with addition of nurse to conduct weekly skin assessments. 

Weekly Skin Assessments:

• No skin issues were noted in the first week post-admission.

• By week two, the resident had excoriation of the buttocks, and by week three, an open area developed on the left buttock.

  • The facility failed to follow CMS guidelines and the Standard of Care (SOC), as there was no documentation of incontinence care being provided during multiple shifts.

Wound Deterioration:

• The open area deteriorated to a stage 3 wound and eventually to a stage 4 wound while the resident was in the facility's care.

• The facility's weekly wound assessments supported the deterioration, and there was a lack of physician notification regarding changes to the wound.

False Minimum Data Set (MDS) Assessment:

• The facility's record lacked documentation of a turning/repositioning program as required by the Resident Assessment Instrument (RAI) Manual.

• Forms used by staff were inconsistently completed, leading to an inaccurately coded MDS and failure to follow the Standard of Practice (SOP).

Conclusion: The review found that the facility failed to follow CMS regulatory guidelines, the SOC, and the SOP, contributing to the development and worsening of the pressure ulcer. This supports the merit of the case, indicating potential negligence on the part of the nursing home.

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