Why Does Minimizing Litigation Liability Matter?
Pressure injuries (ulcers) are targeted for litigation more than other wound types because they often develop while under the care of a healthcare provider, and are perceived to reflect the quality of ostomy care nursing, regardless of whether the ulcer is unavoidable or not.
83% of wound related litigation is settled in the patient’s favor
Individual judgments have been as high as $312 million
Wounds comprise 25% of all medico-legal lawsuits
Wound and skin allegations are the 2nd leading cause of litigation in long term care. “Skin failure” is being referenced more and more as a natural consequence of the dying process - ensuring documentation of clinical findings to support this is critical.
Pressure ulcers become the center of focus by patients and their families and are often documented with cell phone cameras. These images of pressure ulcers are typically disturbing and can seem to support claims of poor ostomy care nursing if not presented alongside a well documented record of the wound care that a facility provided.
Potential Areas of Focus
Several areas of potential focus involve the capability of knowledgeable health care providers caring for the patient and the inclusion of a multi-disciplined team to collaborate on the patient’s wound treatment plan. Below are some targets for attention or improvement.
Documentation is often inaccurate, provides limited meaningful content, or is incomplete. All care provided to patients must meet established standards of care.
Limited or no access to a certified wound expert. Wound nurses and/or wound physicians are often only available during the normal work week.
Clinical staff practicing outside their scope of practice. For example, LPNs/LVNs performing wound care; RNs deciding on wound care treatment without proper MD orders, or RNs doing more extensive debridements than individual state practice acts allow.
Wound care consulting. Dietitians should be consulted regarding the wound patient’s nutritional status and their ability to support wound healing. Dietitians may recommend nutritional supplements to support healing.It’s also worth consulting physical therapists to assist with strategies for patient re-positioning, assessment of seating options, and safe patient handling concerns.
Limited, missing and/or inaccurate wound related documentation. Incomplete documentation is the most common piece of evidence in pressure injury related litigation cases. Wound measurements, especially wound depth, are the most common missing documentation.
Failure to accurately document a non-healing wound or an unavoidable pressure ulcer in long term care facilities. Not all wounds are heal-able, as described by the Skin Changes at Life’s End (SCALE) Document. CMS distinguishes between pressure ulcers (F-Tag 314) that can be avoided if specific interventions are undertaken and those that occur despite appropriate care and are, therefore, unavoidable. The patient record must include supporting documentation such as comorbid conditions, poor nutritional status, patient non-adherence to the treatment plan, etc. to support being labelled as unavoidable. (e.g. patients may develop pressure ulcers as part of end of life that are unavoidable)
Misidentification of the type of wound. Wound etiology drives the treatment plan for the wound; if the wound is misidentified, the wound is not treated appropriately.
Failure to adhere to the documented plan of treatment
Not providing the standard of care. Standards for wound care practice are derived from several agencies including the Agency for Healthcare Research and Quality (AHRQ), the American Nurses Association (ANA) Standards of Clinical Nursing Practice, the American Medical Directors Association (AMDA), the National Pressure Ulcer Advisory Panel (NPUAP), the Wound, Ostomy and Continence Society (WOCN), and Centers for Medicare & Medicaid Services (CMS) as well as individual state nurse practice acts. Standards of care commonly not met include the frequency of wound assessment - which should be every 24-48 hours in an acute-care setting and weekly in a long term care setting and proper use of tools (e.g. Braden Scale) in a pressure ulcer risk assessment.
Limited staff and administration communication with the patient’s family. Research indicates that when patients and family members are included in healthcare discussions and decision-making, they are less likely to litigate. Patients and families should be made aware of new and worsening wounds, available treatment options, and potential outcomes.
How Corstrata Helps Minimize Liability
Corstrata’s clinical team consists of only board certified wound specialists with extensive experience caring for patients with a variety of complex wounds. Our wound specialists are leading wound experts in the U.S., who maintain a current knowledge base regarding the science of wound healing and wound management. They are also experienced legal experts who provide documentation review for legal defensibility.
Corstrata is available 24/7 for assessments and consults.
All Corstrata wound experts are board certified in wound care (ABWM, WOCNCB).
Corstrata’s wound app supports accurate and consistent wound measurements and documentation. The area of the wound is auto-calculated from the photo, and a manual depth measurement is required.
Corstrata wound experts consult regarding accurate identification of the wound etiology and recommend evidence-based, best-practice wound care treatments.
Wound care platform supports compliance with requirements for frequency of wound assessments.
Corstrata’s technology platform allows for video conferencing between our wound expert and the provider caring for the patient.
Corstrata has a comprehensive Pressure Injury (Ulcer) Prevention Program.
Want to learn more about minimizing liability while improving patient outcomes? Great! We’d love to talk.