I spend a lot of time talking about various vascular devices for revascularization procedures. Unfortunately, a subset of patients will have a failed failed attempt at limb salvage and require amputation. Maybe their disease was too severe at the time of presentation, perhaps their was aggressive infection or maybe anatomic factors or the patient's medical condition was prohibitive for any attempt at limb salvage.
For numerous reasons, patients will require minor and major amputations of the extremities. Recent statistics from the National Limb Loss Information Center cite approximately 134,000 annual patient discharges with the diagnosis of limb amputation and the statistic continues to rise. 82% of amputations are related to dysvascular (poor circulation) causes with the rest secondary to cancer or trauma.
Limb loss is trajedty for any patient and presents a source of enormous costs to our healthcare system. These costs include rehabilitation, lost work productivity, nursing home placement and extended care. Importantly, limb amputation is a rising source of malpractice litigation. ment It raises the question of despite the increasing awareness of end users of vascular devices about the prevalence of PAD 1) Are we doing enough to educate the public about treatment options 2) With all of our technology, are we actually increasing the number of people who die with their limb intacts or are we just kicking the can down the road ie delay the inevitable with expensive technology?
find a physician woundcare expert at the Penn Woundcare Center
Wound Care: The Challenges Continue as Litigation Increases
Glenda Motta, RN, MPH, ET
It continues to amaze me how many new products and wound-related treatments enter the market each year. The options for preventing and treating most skin and wound conditions have expanded dramatically. Yet the question still remains: Has wound care improved?
You are likely to answer “no” to that question if you use litigation related to wound care as an indicator. My associates and I have reviewed a record number of cases involving negative outcomes related to wound care. Most often, limb amputation or death from sepsis is the end result of the care provided. Our opinions, provided to attorneys for both plaintiffs and defendants, reveal a striking pattern. The breach of the standard of care is more often related to facility staffing, policies, and procedures than to the actual treatment or products used on the wounds.
Facilities with well-defined policies for prevention, assessment, and intervention most often provide documentation that supports care rendered and its outcomes. Negative patient outcomes are more apt to occur in facilities with weak or outdated policies, poor wound care education, and inadequate staffing. In many cases that we review, the patient has been hospitalized multiple times and transferred to four or more different long-term care facilities.
The most astonishing phenomenon is the lack of knowledge regarding basic wound care. We might assume that nurses are routinely trained in this area, but evidence proves that this is not the case. Even when staffing includes a wound care expert, the attitude of nurses is “that’s not my job.” Consequently, wound care is not incorporated into the general nursing care provided on a daily basis.
Litigation continues to increase as a result of consumer awareness. Families see the wound develop, question why and how this happened, often get little or no response from staff, and then get angry. The anger results in a visit to an attorney.
At the same time, the federal government is increasing its monitoring of care provided to individuals in institutions, particularly those where negative outcomes have been reported. More than 20 nursing home cases have been prosecuted under the False Claims Act, in which the government claims that a provider knowingly billed for substandard health care services. These substandard services result in actual harm to residents, such as malnutrition, dehydration, multiple pressure ulcers, amputations, or death.
The government initiates an investigation of negative outcomes when any of the following occur in an institution: death from any cause, bone fractures, pressure ulcer development and deterioration, malnutrition/significant weight loss, dehydration, development of infection, severe burns, or severe drug reactions.
Sanctions imposed on facilities under investigation include denial of payment for new admissions, denial of payment for all Medicare/Medicaid residents, civil monetary penalties per day and per incident, appointment of a temporary manager, and termination of Medicare/Medicaid provider agreements. Several cases have resulted in closure of the facility, relocation of the residents, referral of nurses and physicians to licensing boards for sanction, and criminal prosecution for deaths related to substandard wound care.
So, with the threat of increased litigation looming, and more importantly, with all the resources available to prevent and treat alterations in skin integrity and chronic wounds as well as to treat wounds appropriately, why aren’t we seeing better outcomes? In many cases, we spend more and achieve less. After all these years, why aren’t we getting the message out and into clinical practice?
Glenda Motta, RN, MPH, ET is president and CEO of GM Associates, Inc., a nationally recognized leader in reimbursement strategic planning and problem solving, clinical research, education, marketing, and sales support.
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