Invest in Wound Care Education To Avoid Legal Risks

When it comes to assessing and treating pressure injuries, diabetic wounds, and venous wounds, investing in expertise up front can help protect your organization against costly wound care liability down the road.

The Agency for Healthcare Research and Quality calculates that more than 17,000 lawsuits related to pressure injuries are filed each year — second only to wrongful death suits.

Understanding the legal implications of gaps in care can help protect all involved: physicians, nurses, other caregivers, and healthcare administrators and leaders. To minimize liability, the entire healthcare team can benefit from training in the following areas:

• Recognizing wound risk factors
• Carefully assessing on admission
• Keeping accurate documentation
• Implementing evidence-based preventive measures
• Providing timely treatment of wounds

Costly Pressure Injuries

According to the Joint Commission Center for Transforming Healthcare, more than 2.5 million patients suffer from pressure injuries in the U.S. each year. These and other wounds can carry a long-term burden of physical and emotional suffering. But pressure injuries also carry the threat of financial harm for healthcare organizations, with the average cost to treat a pressure injury ranging from $21,000 to $152,000.

Because the Centers for Medicare and Medicaid Services will not reimburse healthcare organizations for costs associated with hospital- or facility-acquired pressure injuries, appropriate assessment at the time of admission is vital. Risk assessment tools are one piece of the puzzle.

Along with a thorough assessment, complete documentation of clinical findings at the start is vital to protecting your facility against liability down the road. If pieces are missing, your legal foundation could crumble.

Aware of Wound Care Liability Risks

Wound care training for nurses and other staff can promote a culture attuned to the risks and best treatment protocols. Pressure injury prevention programs can minimize the risk of lawsuits spurred by patients acquiring these wounds in a skilled nursing facility. In addition to hefty financial judgments against the organization, the potential repercussions of lawsuits include damage to a provider’s professional reputation and career options.

To avoid these types of lawsuits, your facility needs a team of nurses and other healthcare professionals who are competent in assessing pressure injuries and documenting findings, confident in following evidence-based standards of care to prevent and treat pressure injuries, and able to communicate the treatment approach to patients and family members.

Skillful Clinician Communication

Factors spurring legal action often involve communication and behavioral issues as well as clinical skills. Many healthcare lawsuits are filed because communication leaves patients or their families feeling discontent, notes Nancy Collins, a registered dietitian with medico-legal expertise. Families who file pressure injury lawsuits may complain of incompetent, inattentive, or uncaring treatment.

Although healthcare providers use the term “pressure injury,” family members often still use the term “bedsore.” That word carries implications of neglect and can inspire guilt in family members who feel that the wound should have been preventable. Showing respect is important, Collins says, because chronic and nonhealing wounds are emotional issues. Empathy and open communication are important as you strive to avoid lawsuits.

A legal review of a pressure injury case considers whether the injury was avoidable or unavoidable. Documentation in the patient’s electronic health record (EHR) is an important part of this determination. For patients with known risk factors, the EHR should clearly show what steps were taken to prevent a pressure injury from occurring.

In general, clinicians should avoid these documentation mistakes:

• Calling all skin integrity problems pressure injuries
• Using the words “sacrum,” “coccyx,” and “buttocks” interchangeably
• Not correctly identifying or describing wounds present on admission
• Confusing “left” and “right” — notes should identify patient’s left or right side
• Lacking a consistent system for documenting routine care, such as repositioning
• Improperly or inconsistently measuring and recording wound size
• Recording the person’s stated weight as actual body weight
• Failing to act on assessments that indicate a patient is at risk
• Not communicating wound status to the responsible family member

Deliberate Wound Documentation

When it comes to minimizing legal risks associated with wound care, the importance of keeping accurate and complete notes is worth repeating. A patient’s medical record serves as a principal foundation for both the defense and plaintiff’s counsel throughout any medical liability litigation process.

When an attorney is making the critical decision of whether to accept or reject a case involving a patient’s or patient’s family’s pressure injury claim, the medical record serves as a single source of truth. Clearly, every member of your staff must be trained and capable of conducting thorough wound assessments and precisely documenting each wound care-related case to ensure this integrity.

For wound care specialists at your organization to be able to make accurate evaluations of the wounds they encounter and subsequently create useful, reliable patient records, Investing in wound care education is critical. When you have a team of competent wound certified clinicians on staff, your organization is not only able to provide the best care possible, but also will be more soundly protected against potentially costly litigation.

Understanding Wound Prevention

Despite the frequency and pervasiveness of pressure injuries, the majority are preventable. Protocols like constant patient risk assessment and implementing well-founded prevention strategies are common first lines of defense.

And although acute care hospitals report using strategies to prevent pressure injuries, those efforts are not always systematically applied to bring consistent results, according to a study of Veterans hospitals. Even when hospitals implemented multipronged prevention strategies — such as policies, education, use of wound care specialists, and review of performance data — the researchers found notable variation in how the strategies were operationalized.

In terms of future action, the researchers noted that nurse leaders should look for opportunities to influence the implementation of prevention programs. Depending on the particular organization, that might mean arranging for specialized wound care training or analyzing the data to find ways to reduce variations in care.

Related Wound Care Liability Concerns

Whether your organization provides acute or long-term care, keeping patients and residents from developing pressure injuries is the ideal situation. Once a patient has a pressure injury, the risks mount, including the following potential complications:

• Infection
• Osteomyelitis
• Fistulas
• Carcinoma
• Sepsis

Those types of complications from hospital-acquired pressure injuries are linked to almost 60,000 U.S. hospital patient deaths each year, according to the International Wound Journal.

Considering the increased mortality rate, the threat of legal action, and the accrued costs related to extended hospital stays and readmission rates, the consequences of inadequate wound care are unwelcome, to say the least.

As a leader, consider wound care education an investment in your team and in the entire organization’s reputation. Doesn’t it make sense to have clinicians learn their lessons from wound care experts instead of legal proceedings?

When you invest in staff education and analyze variations in care, you are taking evidence-based steps to reduce patient morbidity and mortality while limiting fiscal and legal threats to your organization.

With proactive steps, you can use your leadership power to heal the gaps in wound care education.

Editor’s Note: This post was originally published in July 2019 and has been updated.