Pressure Injury Prevention in Long-Term Care: Quality Failures and Liability
Introduction
Pressure injuries, also known as bedsores or decubitus ulcers, remain a persistent challenge in long-term care settings. These injuries are not only painful and debilitating for patients but also represent a significant liability for healthcare organizations. This issue of the UPvision Consulting Insight’s Newsletter explores the clinical standards, legal implications, and quality failures associated with pressure injury prevention. It is designed to inform and engage personal injury attorneys, medical malpractice professionals, and healthcare leaders.
Standards of Care
Preventing pressure injuries requires a multidisciplinary approach that includes risk assessment, regular repositioning, skin inspections, nutritional support, and the use of pressure-relieving devices. Facilities are expected to implement evidence-based protocols and ensure staff are trained to recognize and respond to early signs of skin breakdown. Failure to adhere to these standards can result in preventable harm and legal exposure.
Legal and Case Implications
In legal proceedings, pressure injuries often serve as indicators of neglect or substandard care. Attorneys examine whether the facility conducted timely risk assessments, documented interventions, and followed escalation protocols. Key legal concepts include foreseeability, causation, and damages. Expert nurse consultants play a vital role in evaluating whether the standard of care was breached and if that breach contributed to patient harm.
Quality Failures Case Study
A 78-year-old resident in a long-term care facility developed a Stage 4 pressure injury on her sacrum after being left immobile for extended periods. Documentation revealed inconsistent repositioning and a lack of skin assessments. Despite multiple alerts from nursing staff, no escalation occurred. The resident was hospitalized for sepsis and later passed away. The family filed a malpractice suit, citing failure to prevent and treat the pressure injury. Expert testimony highlighted deviations from standard protocols and inadequate staff training. The case settled for a substantial amount, reinforcing the importance of proactive prevention.
Strategies for Attorneys and Healthcare Organizations
Attorneys should engage expert nurse reviewers to analyze documentation, care protocols, and response timelines. Focus should be placed on identifying gaps in direct care, monitoring and escalation. Healthcare organizations must implement comprehensive prevention programs, including:
Standardized risk assessments using tools like the Braden Scale
Regular staff education and competency validation
Use of care bundles and positioning strategies
Auditing compliance and conducting root-cause analyses
Benchmarking outcomes using nursing-sensitive indicators
Resources and Next Steps
UPvision Consulting, LLC partners with law firms and healthcare agencies to provide expert nurse reviews and bridge the gap between clinical practice and legal standards. Our consultants offer detailed analysis of pressure injury cases and support litigation strategy. Book your case or consultant consultation now https://upvisionconsulting.com/contact-us
Discover everything lawyers need to know, and every healthcare leader should understand, about preventing, documenting, and defending against nursing-related patient safety incidents at the upcoming Attorney’s Resource Conference for sessions on nursing standards of care, expert testimony, and risk mitigation strategies. Register today https://attorneysconference.com/
References
Kandula, U. R. (2025). Impact of multifaceted interventions on pressure injury prevention: A systematic review. BMC Nursing, 24(11). https://doi.org/10.1186/s12912-024-02558-9
De Los Santos, M. (2021). Pressure injury prevention in long-term care. American Nurse Journal. https://www.myamericannurse.com/pressure-injury-prevention/
Joint Commission. (2022). Quick Safety Issue 25: Preventing pressure injuries. https://www.jointcommission.org/en-us/knowledge-library/newsletters/quick-safety/issue-25
Owusu-Ansah, A. (2020). Implementation of Pressure Injury Prevention Intervention in a Long-Term Care Facility. University of Massachusetts Amherst. https://doi.org/10.7275/17547055
