- Wound Care At Mountainview Nursing Center The Assistance Of Patrick Claudius Md In Developing This Case Is Gratefully 1 (223.95 KiB) Viewed 65 times
Treatments The wound's dressing was to be changed once a day, and Accuzyme, a topical medicine, was to be applied with each dressing change. Protein supplements, zinc supplement, and multivitamins were ordered to promote healing of the wound. The resident needed insulin for diabetes. In addition to daily dressing change, the wound was measured once a week. The resident was also referred to a specialized wound care center located 45 minutes away from Mountainview, where he received wound care once a month. At Mountainview, Mr. Harris also received intermittent physical therapy to promote circulation and speech therapy for dysphagia. As a patient in the hospital, before his admission to Mountainview, a Doppler study was conducted to evaluate arterial circulation in the leg. The test showed a severe blockage in the leg. Consultation with a vascular surgeon was recommended. However, Nancy refused the consultation on grounds that surgery presented too great a risk given the patient's medical condition. Nancy also refused the insertion of a G-tube through which the patient could ingest specialized nutritional formulas. A general surgeon had recommended amputation of the leg because of the gangrene. Nancy considered this to be too drastic a measure and did not opt for it. The surgeon as well as the patient's attending physician had discussed with Nancy the risks and benefits of leg amputation versus nonsurgical treatments. According to medical opinion, amputation presented the least risk. However, Nancy had anticipated that over time her father's wound would heal. As time progressed, Nancy showed growing frustration that the wound was not healing. Although some progress would be noted at times, it would be followed by deterioration. The ups and downs in the healing process persisted. Incidents and Outcomes In the final 30 days of the resident's stay at Mountainview, Mr. Harris sustained a fall from wheelchair to floor. He did not have a history of falls even though his gait was unsteady. A restraint was not recommended and was not used. When the resident was in a wheelchair, the nursing staff used a personal alarm that would alert the staff to any forward movement or leaning from the wheelchair. However, by the time the staff came to see what had happened, the fall had already occurred. The nurses did not notice any injuries from the fall, but the resident was sent to the hospital for evaluation. Within 2 weeks of the fall, the resident developed pneumonia and was hospitalized, but he returned to Mountainview within 3 to 4 days. One morning a nurse found that the dressing had slipped from the wound. At times the resident was agitated. Hence, the nurse believed that the resident may have kicked off his dressing while he was agitated. On closer examination, the nurse saw maggots in the wound. The wound was cleaned with saline solution, and the dressing
happened, the fall had already occurred. The nurses did not notice any injuries from the fall, but the resident was sent to the hospital for evaluation. Within 2 weeks of the fall, the resident developed pneumonia and was hospitalized, but he returned to Mountainview within 3 to 4 days. One morning a nurse found that the dressing had slipped from the wound. At times the resident was agitated. Hence, the nurse believed that the resident may have kicked off his dressing while he was agitated. On closer examination, the nurse saw maggots in the wound. The wound was cleaned with saline solution, and the dressing was changed. In the afternoon, maggots were found again. In accordance with nursing protocols, Nancy was informed, and the medical director, who was also the attending physician for this resident, was notified. The resident was transferred to the hospital's emergency room. Mr. Harris never returned to Mountainview. Three months later, the facility was informed that it had been named as the defendant in a lawsuit. Mountainview's corporate office settled the lawsuit out of court for an undisclosed amount. Assignment 1. Evaluate the legal implications of the nursing care that Mr. Harris received while a resident at Mountainview Nursing Center 2. Would a physical restraint be appropriate to prevent falls in this situation? 3. Discuss Mr. Harris' medical care from the standpoint of his rights. 4. In this situation, how would you ensure that the resident's own wishes are carried out? 5. Why do you think the nursing home corporation settled this case out of court? Would you have let the litigation proceed through the court system? Do you think the facility would be held liable? 6. It was assumed that the resident's agitation caused the dressing to dislocate. Could the facility have done anything to prevent that? 7. What actions would you take to assess and improve infection control practices in the nursing home following Mr. Harris's discharge? 8. In this case, Nancy refused the insertion of a G-tube. In a resident who has dysphagia, medical problems such as aspiration, pneumonia, and choking can occur. Can the facility take any proactive steps to protect itself against an allegation of negligence? * An open wound that results from poor blood circulation.