Nursing Home Negligence

If you have a loved-one in a nursing home, you want to know that they are being taken care of just as you would take care of them at home, if you had the means to do it. But in reality, we know this is not the case.

We see continuing cut-backs in the medical industry in efforts to off-set the increase in the rising costs of supplies and services and decreasing payments by insurance companies. This is reflected in less staffing, lacking supplies and cutting corners any way the medical provider is able to – regardless of the impact these actions will have on the patients. This can lead to many serious problems for patients in the nursing home.

Some of the most common problems that we see in nursing homes are patients developing pressure ulcers due to not being turned often enough or if they are incontinent, not having their brief changed often enough. If pressure ulcers are not recognized in the early stages, they can become a serious problem for the patient. If the area is not treated appropriately, the ulcer can become infected and this infection can lead to a more serious infection. There are numerous complications that can occur from a pressure ulcer that is not treated appropriately. Various standardized tools can be used by the nursing home to determine the patient’s risk for developing pressure ulcers and should be completed on all patients when they are admitted to their facility.

Another common problem in the nursing home is patient falls with injury. There are many interventions that can be used in an attempt to prevent a fall, but these interventions are not always implemented by the nursing home staff. Using the bed rails is one way of deterring the patient from rising without assistance. There are also bed alarms that are used to alert the staff when the patient changes from a lying to sitting position. Other interventions that are available are chair alarms, low beds and floor mats. These should be used on any patient that is a risk for falls. A facility should determine the patient’s risk for falls by using a fall risk assessment tool. There are many varieties of these tools available. The most common injuries resulting from nursing home falls are head injuries and hip and/or bone fractures.

Be sure you ask questions of the nursing home on these issues. It is your right to know. Our loved-one’s safety is our top priority. The nursing home should be open and honest with you regarding their protocols on preventing pressure ulcer and fall prevention measures.

The expert who prepared this article has over 18 years of professional experience including home health care, nursing home care and hospital acute care.  She earned her Bachelors of Nursing degree at Duquesne University in Pittsburgh, Pennsylvania.  She also completed training for legal nurse consulting at The Medical Legal Consulting Institute.

This expert has extensive experience with medical record review, regulatory guidelines including Joint Commission standards, policy and procedure analysis and development, nursing home compliance, and hospital compliance.  She is currently self-employed as a Legal Nurse Consultant providing her expertise to clients to assist them with achieving the answers they require and giving patients the answers they deserve.
To have this expert review your case, prepare a report/affidavit and be listed as one of your experts, please contact American Medical Experts at 888-678- EXPERTS.


This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.

Total Knee and Hip Peri-Prosthetic Infections, Failure to Recognize Risks


Are all total joint peri-operative infections considered expected possible complications of these procedures and not the result of negligence? Of course not. Indeed there are cases where all attempts at identifying risk factors and prevention measures are done and still infection occurs without fault or negligence on the part of the surgeon.

Peri -prosthetic joint infection is a serious complication of total joint replacement resulting in significant morbidity, including pain, loss of function, and potential removal of the prosthesis. Evidence based published studies have shown the impact and varying increases in the occurrence of postoperative total joint infections with known risk factors. Risk factors identified and supported by the evidence include prior infection of the joint(knee), superficial surgical site or limb infection(hip and knee), obesity, extended operative time(> 2.5 hrs,hip and knee), and immunosuppression (knee). Other risk factors of great concern are smoking (for knees), positive nasal cultures for Staph, and low albumin and or cirrhosis. Current evidence –based practice standards and the standard of care demand that physicians use the best available evidence in their clinical decision making.

The STANDARD OF CARE in performing joint replacement surgery is that the surgeon, not the referring primary care physician should determine risk factors for a patient considering a total joint arthroplasty.

The STANDARD of CARE would the dictate that the surgeon has an obligation and the duty to discuss these risk factors and the probability of the patient getting a post op infection in the scenario of taking all precautions possible. NEGLIGENCE would be found when a surgeon makes no effort to identify the known published risk factors and does not discuss risk factors with the patient, and then the patient develops a post operative joint infection. The literature reports 40-60% of all post operative total joint infections could be prevented by following the standard of care. For example, The Veteran’s Affairs Medical Center has algorithms for risk factor identification and limits up to an acceptable or not values such as positive nasal cultures, diabetic A1C levels below 7.5, BMI at 40 or below, and off any nicotine products for 2 mos. prior to surgery.

REFERENCES

1. Guide to the Elimination of Orthopedic Surgical Site Infections. An APIC Guide 2010.
2. Prevention of Prosthetic Joint Infections, Wolters Kluwar Health Clinical Solutions, Larry M. Baddour, MD: Ellie Berbari, M.D.
3. Prevention of Surgical Site Infection. PTY Ching, MD
4. The Diagnosis of Peri-prosthetic Joint Infections of the Hip and Knee, Guideline and Evidence Report Adopted by the American Academy of Orthopedic Surgeons Board of Directors---Subsection Risk Factors June 18, 2010.


This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.