Common Types of Preventable Nursing Home Injuries

Attorney Kenneth L. LaBore represents clients with clients who suffer a wide range of  nurisng home injuries from a variety of health care facilities, medical professionals and other sources. Here are some areas of the firm’s practice and information concerning some common other nursing home injuries:

Nursing Home Injuries Are Usually Preventable With Proper Care and Supervision of Residents

Nursing Home Injuries Are Usually Preventable With Proper Care and Supervision of Residents

Nursing Home Injuries – Medication Errors

Medication Errors

Medication Overdose

Medication Given to Wrong Patient

Unnecessary Drugs

Medication Guides

Nursing Home Injuries – Urinary Tract Infections – UTIs

Urinary Tract Infections

Catheter Use

Additional Information About Urinary Infections

Nursing Home Injuries – Aspiration / Tube Care

Choking and Aspiration

Clogged Breathing Tube

Choking Due to Inappropriate Diet

Aspirational Pneumonia

Tracheotomy Tube Care

Nursing Home Injuries – Resident Physical and Sexual Abuse

Physical Abuse of Nursing Home Residents

Verbal Abuse of Nursing Home Residents

Sexual Abuse of Nursing Home Residents

Financial Abuse of Seniors and Vulnerable Adults

Nursing Home Injuries Due to Falls

Fall Injuries

Fractures from Falls

Death Due to Fractures as a Result of Pneumonia / Respiratory Failure

Subdural Hematoma and Traumatic Brain Injury

Safety Equipment to Prevent Fracture Risk

Additional Information About Fall Injuries

Nursing Home Burn Injuries

Burn Injuries

Degrees of Burn Injuries

Scalding / Hot Water Burns

Oxygen Burns

Burn Timing

Nursing Home Injuries – Medical Equipment Failure

Hospital Type Beds

Bed Rails

Hoyer Type Lifts (Patient Lifts)

Oxygen

Medical Monitoring

Call Lights

Wander Guards / Alarms

Injuries From Pressure Wounds – Bedsores

Pressure Sores

Pressure Sore / Pressure Ulcer Staging

Pressure Sores from Failure to Ensure Resident Hygiene

Pressure Sores from Failure to Reposition Residents

Pressure Sore / Pressure Ulcer Resources

Injuries Leading to Death

Wrongful Death

Wrongful Death Jury Instructions

Pecuniary Loss

Punitive Damages

Wrongful Death

If you have a question or concern about elder care and nursing home injuries provided to yourself or a family member contact Minnesota Nursing Home Lawyer Kenneth LaBore for a Free Consultation at 612-743-9048 or toll free at 1-888-452-6589 or by email at: klabore@MNnursinghomeneglect.com

Please see my disclaimer.

 

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NPUAP Stage 4 Pressure Ulcer, Pressure Sore, Decubitus Ulcer

NPUAP Stage 4 Pressure Ulcer, Pressure Sore, Decubitus Ulcer, Now Known as Pressure Injury

Articles About Pressure Ulcers – Prevention in Nursing Homes

As of April 2016, The NPUAP has changed the name of Pressure Ulcers to Pressure Injury or Pressure Injuries and the they are no longer using Roman Numerals for the Stages.  The reason was to better reflect that the sores are injuries not naturally occurring ulcers in most circumstances

Pressure ulcers in adults: family physicians’ knowledge, attitudes, practice preferences, and awareness of AHCPR guidelines.
S Kimura, JT Pacala – The Journal of family practice, 1997 – ncbi.nlm.nih.gov

Dressings and ajunctive therapies: AHCPR guidelines revisited.
LG Ovington – Ostomy/Wound Management, 1999 – ncbi.nlm.nih.gov

A decision support system for prevention and treatment of pressure ulcers based on AHCPR guidelines.
RD Zielstorff, GO Barnett, JB Fitzmaurice… – Proceedings of the …, 1996 – ncbi.nlm.nih.gov

Practice guidelines for the prediction and prevention of pressure ulcers: evaluating the evidence
MB Harrison, G Wells, A Fisher, M Prince – Applied Nursing Research, 1996 – Elsevier

A national study of pressure ulcer prevalence and incidence in acute care hospitals
K Whittington, M Patrick, JL Roberts – Journal of Wound Ostomy & …, 2000 – journals.lww.com

Implementation of a comprehensive skin care program across care settings using the AHCPR pressure ulcer prevention and treatment guidelines.
G Suntken, B Starr, J Ermer-Seltun… – Ostomy/wound …, 1996 – ncbi.nlm.nih.gov

Preventing pressure ulcers: a systematic review
M Reddy, SS Gill, PA Rochon – JAMA: the journal of the American …, 2006 – Am Med Assoc

Quality indicators for prevention and management of pressure ulcers in vulnerable elders
BM Bates-Jensen – Annals of internal medicine, 2001 – Am Coll Physicians

If you or a loved one is the victim of elder abuse or neglect in the form of preventable pressure sores or other injury, contact attorney Kenneth L. LaBore for a free consultation at 612-743-9048 or at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

 

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Department of Justice Launches 10 Elder Justice Task Forces to Investigate Substandard Quality of Care in Nursing Homes

Department of Justice Launches 10 Elder Justice Task Forces to Investigate Substandard Quality of Care in Nursing Homes

Ten New Model Task Forces Lead by DOJ

With an increasing number of elder citizens and increases concerns over substandard nursing home quality of care the Department of Justice initiated a 10 State Elder Justice Task Forces. Bringing together federal, state and local prosecutors, law enforcement, and agencies that provide services to the elderly, to coordinate and enhance efforts to pursue nursing homes that provide grossly substandard care to their residents.

Elder Task Forces Come After Substandard Care

According to Acting Associate Attorney General Stuart F. Delery. “Millions of seniors count on nursing homes to provide them with quality care and to treat them with dignity and respect when they are most vulnerable, Yet, all too often we have found nursing home owners or operators who put their own economic gain before the needs of their residents. These task forces will help ensure that we are working closely with all relevant parties to protect the elderly.”

“The Department of Justice has a long history of holding nursing homes and long-term care providers accountable when they fail to provide their Medicare and Medicaid residents with even the most basic nursing services to which they were entitled,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “By bringing everyone to the table, we will be able to more effectively and quickly pursue nursing homes that are jeopardizing the health and well-being of their residents.”

This website is not intended to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation.

If you or a loved one has suffered an injury from neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact my firm for a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member. To contact Attorney Kenneth L. LaBore, directly please send an email to KLaBore@MNnursinghomeneglect.com or call Ken at 612-743-9048

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What is CMS Medicare MMSEA, Why Do I Have to Pay Back Medicare?

What is CMS Medicare MMSEA, Why Do I Have to Pay Back Medicare?

 

 

 

 

 

 

 

 

CMS MMSEA – the Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers’ Compensation User Guide has been written for use by all Section 111 liability insurance (including self insurance), no-fault insurance, and workers’ compensation Responsible Reporting Entities (RREs). The five chapters of the User Guide—referred to collectively as the “Section 111 NGHP User Guide”—provide information and instructions for the Medicare Secondary Payer (MSP) NGHP reporting requirements mandated by Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA)

A detailed explanation of the CMS MMSEA reporting requirements can be found at NGHP User Guide by CMS.

Section 111: • CMS MMSEA Adds reporting rules; it does not eliminate any existing statutory provisions or regulations. • Does not eliminate CMS’s existing processes, including CMS’s process for selfidentifying pending liability insurance (including self-insurance), no-fault insurance, or workers’ compensation claims to CMS’s Benefits Coordination & Recovery Center (BCRC) or the processes for Non-Group Health Plan MSP recoveries, where appropriate. • Includes penalties for noncompliance. Who Must Report: • An applicable plan. • The term “applicable plan” means the following laws, plans, or other arrangements, including the fiduciary or administrator for such law, plan, or arrangement: (i) Liability insurance (including self-insurance). (ii) No-fault insurance. (iii) Workers’ compensation laws or plans. • See 42 U.S.C. 1395y(b)(8)(F).

Overview of Reporting Requirements to Determine Paid by CMS Medicare

New Medicare CMS MMSEA requirements mandate reporting of claims of elder abuse and neglect.  CMS will check the data base for injuries for that particular person related to the date of the injury and/or the injury treatment itself.  This is a complicated area of the law and requires careful coordination with any potential settlement releases and understanding of appeal process to remove unrelated charges and to reduce the eventual amount claimed by the government in the Final Demand from CMS by the proportionate amount of attorney fees and costs.

If you have questions about elder abuse or neglect seek the advice of an experienced attorney.  For a free consultation with Attorney Kenneth LaBore call him directly at 612-743-9048 or by email at KLaBore@MNnursinghomeneglect.com.

 

 

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Nursing Home Neglect Infectious Disease CRE Bacteria

Nursing Home Neglect Infectious Disease CRE Bacteria

What is CRE?

What is CRE, it is an infectious disease more commonly found in medical and hospital settings, including elder care facilities. It is important to take safety measures to protect residents and healthcare workers from all forms of infectious disease, including staph, MRSA, VRE, C-Diff and CRE.

According to the CDC – CRE, Carbapenem-resistant Enterobacteriaceae is a family of germs that are considered difficult treat due to an increased level of resistance to antibiotics. E. coli is an example of a CRE infection.  Usually healthy people do not get infections.  The risk is increased in healthcare and nursing home settings due to people who require ventilators, urinary catheters, or intravenous catheters, and patients who are taking long courses of antibiotics are at the greatest risk.  Here is a link to more resources in Facilities / Settings.

More Information About CRE Infections

Many people enter elder care facilities and although family members and staff are familiar with the risks associated with falls, medication errors, sexual assault, they may not be as aware of the risks associated with infectious disease and the reasonable measures to be taken to reduce the likelihood of exposure and transmission.

There are state and federal regulations which pertain the standards of care for residents for infectious disease and other infections such as UTIs, pressure sores, and post-surgical wounds.   Make sure that the facility caring for your family member is following infectious disease protocols, such as ensuring cleanliness using bleach and other disinfections, use of gloves, masks, special linen protocols and other measures to reduce the spread of infections, and measures to reduce further spreading such as closed wings of the facilities, etc.

If someone you know acquired an infectious disease in a nursing home or other care facility due to a failure to follow protocols for reducing the risk of infectious disease, I recommend you file a complaint with the Department of Health also contact Attorney Kenneth LaBore for more information on the rights of injured residents of nursing homes and their families.   Mr. LaBore can be reached at 612-743-9048 or toll free at 1-888-452-6589 or by email at Ken@MNnursinghomeneglect.com

Disclaimer

Infectious Disease, CRE, CRE, C-Diff, Staph, MRSA

Infectious Disease, CRE, CRE, C-Diff, Staph, MRSA

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Avoid Bed Sores, Pressures Sores and Wounds

Avoid Bed Sores, Pressures Sores and Wounds referred to after April 2016 as Pressure Injuries

Avoid Pressure Sores / Decubitus Ulcers/ Pressure Injury

How do you help avoid pressure sores or ulcers in nursing home residents?  One of the most prevalent forms of preventable elder abuse and neglect, often called decubitus injury ulcer, pressure ulcer or bed sores. Pressure sores are usually an indication that the nursing home staff is not assisting the residents to move freely or not turning them as often as necessary. The Federal Code which regulations Nursing Homes considers pressure sores to Be “AVOIDABLE” and therefore preventable:

Pressure injury ulcers / sores. Based on the comprehensive assessment of a resident, the facility must ensure that— (1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and (2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. (42 CFR § 483.25(c))

Understanding How to Avoid Pressure Sores – Pressure Injuries– Bed Sores

Pressure sores also referred to as decubitus ulcers and as of April 2016 as considered pressure injuries are areas of damaged skin and tissue that develop due to a reduction in circulation often accompanied by excessive periods of unrelieved pressure on the affected area. In order to properly track the care provide for a pressure sore, it is essential that the staff understand the correct way to identify and chart the stages of pressure sores. National Pressure Ulcer Advisory Panel The National Pressure Ulcer Advisory Panel (NPUAP) serves as the authoritative voice for improved patient outcomes in pressure ulcer prevention and treatment through public policy, education and research.

Pressure Injury Ulcer Stages Revised by NPUAP Pressure Ulcer Image Library Pressure Ulcer Category / Staging Illustrations Untreated Bedsore/Pressure Ulcer/Pressure Sore In April 2016, the National Pressure Ulcer Advisory Panel has redefined the definition of a pressure ulcer and the stages of pressure sores, including the original 4 stages and adding 2 stages on deep tissue injury and unstageable pressure ulcers.

Stage 1: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. Further description: The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk)

Stage 2: Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Further description: Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation. *Bruising indicates suspected deep tissue injury

Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Further description: The depth of a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible or directly palpable.

Stage 4: Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling. Further description: The depth of a stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable.

Unstageable Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Further description: Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.

For more information see npuap.org. This organization is an excellent resource for caregivers and family members dealing with individuals that are at risk for pressure sores. Bed sores are not always preventable but, in most instances, a nursing home staff should be aware of the pressure and wound building up around the area. It is the nursing staff’s duty to ensure that the elderly are looked after and this means ensuring they are moved and taken care of if the first stage of bed sores are present.

Pressure ulcers are “preventable” in most situations. Make sure your loved on is getting the proper care including:

• Proper Hydration and Nutrition;

• Is getting turned or rotated every 2 hours if unable to get up from bed or from wheel chair;

• Sheets are keep clean and smooth (without wrinkles); • A special pressure relieving mattress or wheel chair cushion is used;

• All wounds should be measured and evaluated (Staged from 1-4) using the “Braden Scale” or similar method;

• Wounds are immediately addressed in the early stages and appropriate wound care is performed by a qualified professional, including the use of wound vac devices and other methods to reduce the size and degree of the ulcers. Questions to ask the Nursing Home regarding Pressure Sores: • Request Nursing Home Policies regarding Pressure Sores.

• Was the sore acquired at the facility?

• Has the resident been assessed for Skin Breakdown Risks, what is the Braden scale staging? (Stages 1-4)?

• Does the nursing home have photos of the wound? • Has the resident’s family and physician been notified that there is an ulcer?

• What was the resident’s treatment plan / care plan for the ulcer. Was there wound care? • Was the wound care provided by the facility or outsourced?

Please note that this article is for educational purposes.  If you have a legal question contact a lawyer directly for a legal opinion.

If you notice your loved one has pressure injury sores, then it should act as a warning sign that the nursing staff may not be provided adequate health and personal care. You should contact a nursing home neglect attorney immediately to discuss how to hold the nursing home accountable.

Attorney Kenneth L. LaBore has years of experience handling nursing home abuse and neglect cases and can assist you in determining if there is a claim related to preventable pressure sores. For a free consultation call 612-743-9048 or toll free at 1-888-452-6589 or fill out the form on this page to discuss your nursing home rights and your legal options. Email: KLaBore@mnnursinghomeneglect.com

Nursing Home Resident Prevent Elder Abuse

Nursing Home Resident
Prevent Elder Abuse

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Fractures from Falls Include Pelvic, Hip and Femur Fractures, Hand and Arm Injuries and Others

Fractures from Falls Include Pelvic, Hip and Femur Fractures, Hand and Arm Injuries and Others

Fractures from Falls in Nursing Homes

One of the most preventable forms to nursing home residents are fractures from falls.  According to the CDC Tips in Preventing Falls Among Seniors – falls account for 87 percent of all fractures for people 65 years and older, and they are the second leading cause of spinal cord and brain injury among older adults. There are many ways to reduce fractures from falls.  First you can assess the resident needs and risks and take necessary steps to ensure the resident is receiving the necessary care and supervision to keep them safe from accidents.  Nursing homes and other elder care facilities need to take reasonable measures to avoid falls and the injuries that occur as a result.    It is essential that nursing homes have well trained qualified and competent staff to assess and care for the residents.  Often times delays in answering call lights lead to the resident attempting to assist themselves when they are unable and they end of falling from bed or from the toilet.

Fractures from Falls – Information

I have  videos with information related to reducing falls in nursing home which provides additional information on regulations which are designed to reduce the risk of fractures from falls in nursing homes.  In addition to fractures another common and very serious injury often suffered from falls is a head injury with resulting subdural hematoma or traumatic brain injury.   Here is some additional resources for information pertaining to preventable falls and the resulting injuries in nursing homes.

Fractures from Falls – Consult Kenneth LaBore

If you have concerns over injuries sustained by a loved one due to the neglect or abuse of a nursing home or their staff call Attorney Kenneth LaBore for a Free Consultation.  Ken can be reached at his direct dial number at 612-743-9048 or toll free at 1-888-452-6589 or send him an email at Klabore@MNnursinghomeneglect.com.

978477_65609662

 

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Bathroom Fall Prevention Falls in Bathroom one of the Most Common Ways Seniors Fall and Suffer Fractures

Bathroom Fall Prevention Falls in Bathroom one of the Most Common Ways Seniors Fall and Suffer Fractures

Falls in Bathroom Can Be Prevented

Falls in the Bathroom, according to a new CDC study published in the Morbidity and Mortality Weekly Report (MMWR), an estimated 234,000 people ages 15 and older were treated in U.S. emergency departments (ED) in 2008 for injuries that occurred in bathrooms. Four out of 5 of these injuries were caused by falls—which can have especially serious consequences for older adults. Almost one-third (30 percent) of adults aged 65 and above who were injured in bathrooms were diagnosed with fractures. Among adults aged 85 and older, 38 percent were hospitalized as a result of their injuries. To prevent fall in the bathroom the CDC recommends that additional safety measures be taken to protect all users, including adding non-slip surfaces and grab inside and outside the tub or shower to reduce the likelihood of slips and falls and installing grab bars next to the toilet for additional support, when needed.

Nursing Homes and Other Care Facilities can Reduce Falls in the Bathroom and Bedroom

 Nursing homes can reduce the risk to their residents from falls, by making sure that:

1) The call light is answered without delay so that residents do not need to wait and eventually attempt to transfer and go to the bathroom on their own.

2) Residents should not be left unattended in the bathroom or on the toilet when the care plan calls for assistance.

3) Patients with Alzheimer’s and Dementia should be monitored and given a tab alarm which should alert staff if they are attempting to get out of bed or go to an unsupervised area.

4) Risks such as night stands, oxygen tanks and other medical equipment should be placed in a location where the resident is unlikely to strike the object in a fall.

5) Residents who have a risk of falling from their bed should have floor mats to provide a protect surface in the event of a fall to reduce the chance of fractures.

If you have a loved one who was injured in a nursing home or other elder care facility by abuse or neglect, call an attorney who has handled hundreds of claims on behalf of vulnerable adults and knows how to hold facilities accountable.  Ken LaBore at 612-743-9048 or by email at klabore@MNnursinghomeneglect.com

Fractures in Nursing Homes Due to Falls, Fall Injuries

Fractures in Nursing Homes Due to Falls, Fall Injuries

 

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Medication Error in Nursing Home

Medication Error in Nursing Home

Medication Theft From Nursing Home Residents

There are many reasons that seniors and vulnerable adults do not always receive the correct medication in nursing homes, assisted living, home health care and other settings.  Some are simple but preventable medication errors: such as medication overdoses or medication given in error to the wrong patient, others are more nefarious such as the administration of unnecessary medications to help the “medicate” the residents into being less active and hence less work to supervise.  One of the most common forms of neglect is the theft of necessary pain and other narcotic medications from seniors who truly need them.   The drugs have value on the black market or are taken by the thieves themselves. 

The theft of necessary medications is a common problem throughout the industry and stricter controls need to be taken to protect vulnerable elderly residents who often are unable to advocate for themselves. In addition to suffering from pain that was meant to be controlled with the prescribed medication, the senior may be at increased risk of other injuries such as a serious fall, or the development of pressure sores, or a urinary tract infection due to immobility and other serious health risk due to the medication theft.

Report Medication Theft

If you are aware of possible medication theft protect the resident or patient and contact the Minnesota Department of Health or your local police department who will be able to investigate. If you have a concern about medication errors or other nursing home neglect contact attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at KLaBore@MNnursinghomeneglect.com.

Medication  Nursing Home Medication Error, Medication Theft

Medication
Nursing Home Medication Error, Medication Theft

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Falls Resulting in Hip Fractures in Nursing Home Residents

Hip fractures are a very common type of injury after a serious fall in an elderly person.  An CDC article titled Falls and Hip Fractures Among Older Adults: states that Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.

According to the Center for Disease Control article titled: Falls Among Older Adults, An Overview – fractures among older adults are caused by falls.  According to the CDC, one in every three adults age 65 or older falls and 2 million are treated in the emergency departments for fall-related injuries.  The risk of falling increases with each decade of life.  The National Council on Aging has a  concerning falls and the resulting injuries, including TBIs, hip and other fractures.

The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand. Many of the fracture injuries in nursing homes occur during transfers from bed or a wheelchair.  The lack of qualified and well trained staff is the main cause of injury I have seen in my practice.  Nursing homes must provide sufficient staff to provide cares for residents so the have quality of life and receive the best care practicable.

If you have questions about hip fractures or other fractures from falls or other neglect contact an experienced top rated Elder Abuse Attorney, Kenneth LaBore for a free consultation.

Hip Fracture, Injury Break,

Hip Fracture, Injury Break,

 

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Trauma Brain Injury

Trauma Brain Injury

Traumatic Brain Injury Due to Falls in Nursing Homes

According to the Center for Disease Control –  a Traumatic brain injury (TBI) is a serious public health problem in the United States.  Each year, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability. Every year, at least 1.7 million TBIs occur either as an isolated injury or along with other injuries. A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury. The majority of TBIs that occur each year are concussions or other forms of mild TBI.

Severe Traumatic Brain Injury

In another article from CDC titled: Severe Traumatic Brain Injury – TBI is a contributing factor to a third (30.5%) of all injury-related deaths in the United States.1 On average, approximately 1.7 million people sustain a traumatic brain injury annually.

The prevention of falls which according to the CDC is the leading cause of TBI is crucial.  People over the age of 75 have the highest rates of TBI- related hospitalizations and deaths.  It is imperative that caregivers are trained on how to recognize the signs of a TBI (such as a subdural hematoma) after a fall injury occurs; and take appropriate interventions to ensure the resident receives necessary medical care without delay.

The CDC offers the following Materials for the Prevention and Identification of Traumatic Brain Injury

tri-fold brochureTri-fold Brochure   “Preventing Traumatic Brain Injury in Older Adults: Information for Family Members and Other Caregivers”

bookletBooklet for Older Adults “Preventing Traumatic Brain Injury in Older Adults”

posterPoster  Facts about TBI in Older Adults

eCard E-card “TBI is a Special Health Concern or Older Adults”

eCard E-card “Fall-related TBI Prevention Steps”

 

If you have questions related to abuse and neglect in a nursing home or other elder care facility contact Attorney Kenneth LaBore for a free consultation at 612-743-9048 or by email at klabore@MNnursinghomeneglect.com

 

666036_37740810

 

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Fall Prevention in Nursing Homes

Fall Injury Prevention in Nursing Homes

Fall Injury Prevention in Nursing Homes

According to the Center for Disease Control, Falls Among Older Adults: An Overview – older adults can remain independent and reduce their chances of falling.  They can:

  • Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. 
  • Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.
  • Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision. Consider getting a pair with single vision distance lenses for some activities such as walking outside.
  • Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways and improving the lighting in their homes.

To lower their hip fracture risk, older adults can:

  • Get adequate calcium and vitamin D—from food and/or from supplements.
  • Do weight bearing exercise.
  • Get screened and, if needed, treated for osteoporosis.

Fall Injury Prevention – Learn Not to Fall – Is an organization dedicated to reduce fall injuries in seniors through education:

 Some Additional Fall Injury Prevention Resources Include:

If you have concerns over injuries sustained by a loved one due to the neglect or abuse of a nursing home or their staff call Attorney Kenneth LaBore for a Free Consultation.  Ken can be reached at his direct dial number at 612-743-9048 or toll free at 1-888-452-6589 or send him an email at klabore@MNnursinghomeneglect.com

978477_65609662

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Injuries from Fractures

Injuries from Fractures

Articles About Fall Injuries

The attached list of references is from a Center for Disease Control article titled: Falls Among Older Adults: An Overview, which states that each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head injuries, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable.

  • Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community–living older adults: a 1–year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8):1050–6.
  • Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community–dwelling older persons: results from a randomized trial. The Gerontologist 1994:34(1):16–23.
  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online].   Accessed November 30, 2010.
  • Stevens JA.  Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005. MMWR 2006a;55(45).
  • Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006b;12:290–5.
  • Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall–related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3.
  • Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma–Injury, Infection and Critical Care 2001;50(1):116–9.
  • Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992–1994. Academic Emergency Medicine 2000&359;7(2):134–40.
  • Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7.
  • Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990; 16(3): 717–40.
  • Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing 1997;26:189–193.
  • Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 1990–98: sex, race, and ethnic disparities. Injury Prevention 2002;8:272–5.
  • Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5.
  • Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevention 2005b;11:115–9.
  • National Hospital Discharge Survey (NHDS), National Center for Health Statistics. Available at: www.cdc.gov/nchs/hdi.htm.  Assessed September 14, 2011.
  • Stevens JA. Falls among older adults–risk factors and prevention strategies. NCOA Falls Free: Promoting a National Falls Prevention Action Plan. Research Review Papers. Washington &340;DC)&358; The National Council on the Aging; 2005a.

If you have concerns over injuries sustained by a loved one due to the neglect or abuse of a nursing home or their staff call Attorney Kenneth LaBore for a free consultation.  Ken can be reached at his direct dial number at 612-743-9048 or send him an email at klabore@MNnursinghomeneglect.com.

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Hip Fracture and Other Fall Related Injuries

Hip Fracture and Other Fall Related Injuries

Fall Injuries Sustained by Minnesota Seniors is a Serious Issue

According to the Minnesota Department of Health, and the CDC Best Practices to Prevent Falls, falls are the leading cause of injury for children, and for all adults 35 and older. They account for almost half the hospitalized injuries and are the leading cause of injuries treated in emergency departments. Minnesotans of all ages have fall death rates one and one-half times higher than the U.S. rates, and among the elderly, Minnesota fall death rates are more than three times greater than the national rate. One of every three Americans 65 years old or older falls each year, and falls are the leading cause of injury deaths among this age group. Falls account for 87 percent of all fractures for people 65 years and older, and they are the second leading cause of spinal cord and brain injury among older adults.

The National Osteoporosis Foundation reports that a total of 15,802 persons aged 65 years and older died as a result of injuries from falls in 2005. According to the Center for Disease Control in an article title Falls Among Older Adults: An Overview they relate the following outcomes due to falls sustained by the elderly:

  • Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.
  • Falls are the most common cause of traumatic brain injuries (TBI). In 2000, TBI accounted for 46% of fatal falls among older adults.
  • Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
  • Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling.

Nursing Home Providers Have a Duty to Prevent Fall Injuries

Due to the serious nature of falls in the elderly prevention is very important. According to an article produced by the American Academy of Orthopaedic Surgeons,  The absolute goal is to prevent a fall injury. Federal law nursing home must ensure that the resident receives adequate supervision and assistive devices to prevent accidents. 42 CFR §483.25 (h). The facility must ensure that—

(1) The resident environment remains as free of accident hazards as is possible; and (2) Each resident receives adequate supervision and assistance devices to prevent accidents.

Prevention Nursing Home Fall Injuries Requires Adequate Numbers of Well Trained Staff

Falls in a nursing home often occur due to a delay in the residents receiving necessary care, usually related to transferring or toileting.  The resident who often times may suffer from cognitive difficulties due to medications, Alzheimer’s / Dementia or other conditions and may not understand the risks associated with self transfer or a trip to the bathroom or they simply cannot wait any longer.  Each nursing home resident should receive care consistent with their care plan and doctor’s orders provided when needed.  Call lights need to be responded to without undue delay.  Further residents need to be protected from obvious risks including, falls from bed, falls during transfer, falls when toileting or showering, falls from wheel chairs and other sitting areas.  Each risk needs to be assessed by the nursing home staff and safety interventions taken to reduce the risk of an adverse outcome.

Kenneth L. LaBore is an attorney experienced with the federal and state regulations and industry standards of care created to reduce the likelihood of injuries to nursing home residents from falls and other preventable accidents. To contact Attorney Kenneth L. LaBore, directly please send an email to: KLaBore@mnnursinghomeneglect.com, or call Ken at 612-743-9048 or toll free at 1-888-452-6589 to discuss your case.

666036_37740810

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Staph Infections in Nursing Homes is a Risk to Watch

Staph – Staphylococcus aureus is a common bacterium found on the skin and in the noses of up to 25% of healthy people and animals. Staphylococcus aureus is important because it has the ability to make seven different toxins that are frequently responsible for food poisoning.  Staph investigations in nursing homes can be greatly reduced with proper hygiene an infectious disease procedures.

11155 lores Staph Infections in Nursing Homes

Information About Staff Infections from the Center for Disease Control

What is Staphylococcus?
What is staphylococcal food poisoning?
What are the symptoms of staphylococcal food poisoning?
How do I know if I have staphylococcal food poisoning?
Is a sick staph patient infectious?
How should a patient with suspected staphylococcal food poisoning be treated?
How can staphylococcal food poisoning be prevented

If you or a loved one has suffered an injury from Staph, C-Diff, MRSA, VRE, CRE or any other infectious disease or other neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact Attorney Kenneth L. LaBore, directly please send an email to KLaBore@mnnursinghomeneglect.com, or call Ken at 612-743-9048 or call him at his direct toll free number 1-888-452-6589.

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NPUAP Stage 2 Pressure Injury

NPUAP Stage 2 Pressure Injury

Pressure Sore Resources – Pressure Injury

According to the Minnesota Department of Health (the department that regulates nursing homes) in an article titled’ “A Physician’s Practioner’s & Clinician’s Reference Guide for Pressure Ulcer Prevention & Treatment”: a pressure ulcer [pressure sore, decubitus ulcer, bed sore] is any lesion caused by unrelieved pressure that results in damage to the underlying tissue. Although friction, shear and moisture are not primary causes of pressure ulcers, friction, shear and moisture are important contributing factors to the development of pressure ulcers. Pressure ulcers are generally found over bony prominences.

Pressure injury ulcers are staged according to their extent of tissue damage. The current definitions for the stages of pressure ulcers are: 

Stage 1: An observable, pressure-related alteration of intact skin, whose indicators as compared to an adjacent or opposite area of the body may include changes in one or more of the following parameters: Skin temperature (warmth or coolness), Tissue consistency (firm or boggy), sensation (pain or itching) and/or a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue or purple hues.
Stage 2: Partial thickness skin loss involving epidermis, dermis or both. The ulcer is superficial and presents clinically as an abrasion, blister or shallow crater.
Stage 3: Full thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.
Stage 4: Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage IV pressure ulcers.

Minnesota Department of Health – Adverse Health Events Factsheet – Pressure Sore Resources – Pressure Ulcers – Pressure Injury

What is a pressure ulcer?
How do pressure ulcers happen?
What should hospitals [and nursing homes] should do to prevent pressure ulcers?
What can I do to prevent pressure ulcers?

The Minnesota Department of Health Recommends the Following Pressure Sore Resources

www.wocn.org (Wound, Ostomy & Continence Nurse Society)
www.ahrq.gov (Agency for Health Care Research and Quality)
www.amda.org (American Medical Directors Association)
www.npuap.org (National Pressure Ulcer Advisory Panel)
www.medqic.org (Medicare Quality Improvement Community Initiatives)
www.healthinaging.org (Sponsored by The American Geriatrics Society)

National Pressure Ulcer Advisory Panel Pressure Ulcer Resources

The NPUAP has developed illustrations of the stages of pressure ulcers (Category/Stage I-IV, suspected deep tissue injury, unstageable). These illustrations and pressure sore resources can be downloaded from the NPUAP:

NPUAP Educational and Clinical Pressure Sore Resources

NPUAP Push Tool Information Pressure Sore Resources

The Pressure Ulcer Scale for Healing (PUSH Tool) was developed by the National Pressure Ulcer Advisory Panel (NPUAP) as a quick, reliable tool to monitor the change in pressure ulcer status over time.

NPUAP Position Statements Pressure Sore Resources

Additional Pressure Ulcer Resources

 The information contained on this blog article is for educational purposes only, speak directly with a lawyer for a legal opinion, please review my disclaimer.

 

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NPUAP Stage 2 Pressure Injury

NPUAP Stage 2 Pressure Sore – Pressure Injury

One of the most common forms of elder abuse in nursing homes is the pattern of neglect which leads to pressure sores.  Pressure injury sores are also known as decubitus ulcers or bed sores.  The reason they are called “bed sores” is that pressure sores usually result on areas of the body which are considered the “pressure points” when a person is in bed on their back.  These areas are the most prone to pressure sores and include: the back of the head, the shoulders, and more so to the rear end in the coccyx region and the heels of the feet.  If a person is unable to ambulate and turn themselves in the bed it is essential that the facility staff assists with this basic activity.  Nursing homes need to maintain adequate numbers of well trained staff to be able to provide care which is essential for good health, such as food, water, turning and repositioning, assistance with toileting to avoid urinary tract infections and infectious disease. 

What are the Risk Factors for Pressure Sores?

Inability to reposition in bed, chairs, etc. without assistance • Repeated infections, such as MRSA, C-Diff., VRE • Diabetes Malnutrition or inadequate nutrition Urinary incontinence • Past history of dehydration • Multiple chronic conditions such as UTIs Use of medications such as: diuretics, antidepressants, psychotropics, or anti-anxiety medications, laxatives, or steroids

What are the Federal Regulations Which Pertain to Nursing Homes and Pressure Sore Prevention?

There are federal and state regulations which pertain to the care and treatment nursing home residents and measures which must be taken to reduce the risk of receiving pressure sores and required measures once a sore has started.  The Federal Code which regulation overns nursing homes considers pressure ulcers to Be “AVOIDABLE” and therefore preventable: Pressure sores. Based on the comprehensive assessment of a resident, the facility must ensure that—(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and (2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. (42 CFR § 483.25(c)) Minnesota Statute 144A.04, Subd. 12. mandates that the position of residents unable to change their own position must be changed based on the comprehensive assessment and care plan.

Skin Assessments Wound Staging and PUSH Charts Can Reduce Pressure Sore Risk

Preventative measures are important to reduce pressure sores in nursing home residents, in addition, once there is any noticeable change in the condition of the skin the nursing home should be taking efforts to document the size, shape and other characteristics of the wound to assist with monitoring its progress towards healing or a worsening condition.  Pressure Sore Staging is a critical part of proper wound care and treatment.  The National Pressure Ulcer Advisory Panel, NPUAP has developed illustrations of the categories/stages of pressure injury ulcers (Category/Stage 1-4, suspected deep tissue injury, unstageable). These pressure sore illustrations can be downloaded from the NPUAP website directly to your computer at no cost, if for educational purposes.

The NPUAP developed the Pressure Ulcer Scale for Healing (PUSH Tool) was developed by the National Pressure Ulcer Advisory Panel (NPUAP) as a quick, reliable tool to monitor the change in pressure ulcer status over time.

The CDC produces materials on the issue of pressure ulcers among nursing home residents.  Here is additional information on bed sore identification, treatment and other pressure sore resources.   Healthline has an article on the causes and treatments, which include unrelieved pressure, poor hydration, lack of nutrition, lack of movement, etc. If someone you love has suffered from a pressure sore or other serious injury due to poor care in a nursing home or other elder residential facility you need an experienced Attorney with a history of holding negligent nursing homes accountable.  Contact attorney Kenneth L. LaBore who handles cases throughout Minnesota at 612-743-9048 or toll free at 1-888-452-6589.  Ken can be reached by email at KLaBore@MNnursinghomeneglect.com.

This article is for educational purposes and is not legal advice only see an attorney for a legal opinion, please see my disclaimer.

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Failure to Reposition to Avoid Bed Sores, Pressures Sores and Wounds

Failure to Reposition to Avoid Bed Sores, Pressures Sores and Wounds

Failure to Reposition Residents Causing Pressure Sores

Failure to reposition residents causes pressure sores. According to: Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Chapter 12. Pressure Ulcers: A Patient Safety Issue by Courtney H. Lyder, Elizabeth A. Ayello, pressure ulcers develop when capillaries supplying the skin and subcutaneous tissues are compressed enough to impede perfusion, leading ultimately to tissue necrosis. Normal blood pressure within capillaries ranges from 20 to 40mm Hg; 32mm Hg is considered the average. Thus, keeping the external pressure less than 32 mm Hg should be sufficient to prevent the development of pressure ulcers. However, capillary blood pressure may be less than 32 mm Hg in critically ill patients due to hemodynamic instability and comorbid conditions; thus, even lower applied pressures may be sufficient to induce ulceration in this group of patients. Pressure ulcers can develop within 2 to 6 hours.

There are several areas on the body where if the pressure is not off loaded by repositioning and proper support surfaces.  The National Pressure Ulcer Advisory Panel (NPUAP) coordinated the development of a uniform terminology, test methods and reporting standards for support surfaces. Theses guidelines provide an objective means for evaluating and comparing support surface characteristics.

The AHRQ website for providers and clinicians in a patient safety article – pressure ulcers remain a major health problem affecting approximately 3 million adults. In 1993, pressure ulcers were noted in 280,000 hospital stays, and 11 years later the number of ulcers was 455,000. The Healthcare Cost and Utilization Project (HCUP) report found from 1993 to 2003 a 63 percent increase in pressure ulcers, but the total number of hospitalizations during this time period increased by only 11 percent. Pressure ulcers are costly, with an average charge per stay of $37,800.

Failure to Reposition – Nursing Homes Have a Duty to Prevent Pressure Sores

Federal regulations contained in 42 CFR 483 and in the surveyors guidance tool called Ftags nursing homes have a duty to prevent pressure sores which are not clinically unavoidable.  This means provide the necessary nutrition, hydration, hygiene, assistance with turning and repositioning.

Ftag 314 – 42 CFR 483.25 (c) Pressure sores

Based on the comprehensive assessment of a resident, the facility must ensure that –

  • A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and
  • A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing”

Ftag 314 Intent

  • Promote the prevention of pressure ulcer development
  • Promote healing of pressure ulcers that are present
  • Prevent development of new pressure ulcers

Failure to Reposition – Avoidable versus Unavoidable Pressure Ulcers

Definitions of Avoidable and Unavoidable Pressure Ulcers (Centers for Medicare and Medicaid, 2004)

Avoidable Pressure Ulcer:

“Avoidable” means that the resident developed a pressure ulcer and that the facility did not do one or more of the following: evaluate the resident’s clinical condition and pressure ulcer risk factors; define and implement interventions that are consistent with resident needs, resident goals, and recognized standards of practice; monitor and evaluate the impact of the interventions; or revise the interventions as appropriate. (483.25c/TagF314)

 Unavoidable Pressure Ulcer:

“Unavoidable” means that the resident developed a pressure ulcer even though the facility had evaluated the resident’s clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with resident needs, goals, and recognized standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate. (483.25c/TagF314)

Failure to Reposition – Minnesota Pressure Sore Reposition and Turning Regulation

Minnesota Statutes 2008, section 144A.04, is amended by adding a subdivision to read: Subd. 12. Resident positioning. Notwithstanding Minnesota Rules, part 4658.0525, subpart 4, the position of residents unable to change their own position must be changed based on the comprehensive assessment and care plan.

Why Do Residents Get Pressure Sores?

According to www.nursingassistanteducation.com the following are common reasons which contribute to pressure sores:

  • Age – oxygen levels in the skin decrease over time
  • Lack of mobility – effects the circulation and blood flow due to a failure to reposition residents
  • Poor Diet – nutrition is necessary to maintain good skin health
  • Moisture – wet skin is at greater risk for pressure ulcers
  • Mental, neurological and other physical problems, effects ability to advocate for themselves and pain responses
  • Friction and shearing – these forces can assist in skin break down
  • Bed sheets and wheelchairs, with wrinkled areas or hard objects – can cause abrasion and cuts leading to skin breakdown
  • Pressure ulcers in the past – the skin may be compromised and at greater risk due to previous open sores

Turning and repositioning of nursing home residents who require assistance with mobility is essential and one of the most common forms of elder abuse and neglect found in Minnesota nursing homes.

According to the Pressure Ulcer Prevention Training Module, prepared by The Anna and Harry Borun Center for Gerontological Research: nationally, the prevalence of PU among nursing home residents is 14% for high-risk individuals.  In a study with a sub-sample of 98 PU risk residents who were unable to reposition themselves independently, based on our performance assessment. All these residents then were in need of two-hour repositioning to prevent PU development. And all had medical record documentation that they were receiving it. But when we used wireless thigh movement monitors to detect actual repositioning, we found that only 26% of these residents were repositioned an average of every three hours or less. Moreover, their average longest time in one position was 5.6 hours, and ranged from 4 to 12 hours.

NPUAP provides the following Pressure Ulcer Prevention Points

  1. Risk Assessment
  2. Skin Care
  3. Nutrition
  4. Mechanical Loading and Support Surfaces
  5. Education

A full PDF file with this information can be found here

If you or a loved one is the victim of elder abuse or neglect in the form of preventable pressure sores or other injury, contact attorney Kenneth L. LaBore for a free consultation at 612-743-9048 or at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com.

NPUAP Stage 4 Pressure Ulcer, Pressure Sore, Decubitus Ulcer

NPUAP Stage 4 Pressure Ulcer, Pressure Sore, Decubitus Ulcer

 

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NPUAP Stage 4 Pressure Injury

NPUAP Stage 4 Pressure Ulcer, Pressure Sore, Decubitus Ulcer, Pressure Sore Staging

Nursing Home Pressure Sore Staging

Pressure sore staging – according to the Mayo Clinic, pressure sores or pressure ulcers also called “bedsores” — are injuries to skin and underlying tissues that result from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heel, ankles, hips or buttocks.  The elderly and people with medical conditions are at greater risk of bedsores especially if they require assistance with repositioning or turning themselves in bed or their wheelchair.  The sores can develop quickly and once they occur can be difficult to heal, therefore prevention of pressure ulcers is very important.

Pressure Sore Staging

The following definitions are cited by medicaledu.com taking the material from AHCPR Guidelines which are consistent with the information provided by the National Pressure Ulcer Advisory Panel:

Stage 1

Nonblanchable erythema of intact skin, the heralding lesion of skin ulceration. In individuals with darker skin, discoloration of the skin, warmth, edema, induration, or hardness may also be indicators.

A Stage I pressure ulcer is an observable pressure related alteration of intact skin whose indicators as compared to the adjacent or opposite area on the body may include changes in one or more of the following:
skin temperature (warmth or coolness), tissue consistency (firm or boggy feel) and/or sensation (pain, itching).
The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.

Stage 2

Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

Stage 3

Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

Stage 4

Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage 4 pressure ulcers.

Pressure Sore Staging Illustrations from NPUAP

NPUAP Free Resource Category/Staging Illustrations:

Pressure Sore Staging – PUSH Tool

The Pressure Ulcer Scale for Healing (PUSH Tool) was developed by the National Pressure Ulcer Advisory Panel (NPUAP) as a quick, reliable tool to monitor the change in pressure ulcer status over time.

Pressure Sore Staging – Prevention

In addition to repositioning and turning bedsores, pressure sores can also occur from either a single source or a variety forms of neglect working together, such as dehydration, medical overdose, medical devices such as splints or braces, feet dragging from a wheelchair and many other preventable sources.   Care and attention should be given to ensure that every resident is receiving care in compliance with their plan of care, including adequate hydration, nutrition, hygiene, and assistance with repositioning to avoid pressure sores.  Federal regulations state that  the facility must ensure that—a resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. 42 CFR 483.25(c)

If you have questions about pressures sores or other neglect or abuse to a nursing home resident contact attorney Kenneth LaBore at 612-743-9048 or toll free at 1-888-452-6589 or by email at: klabore@MNnursinghomeneglect.com

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Wrongful death actions are a distinct legal claims which can be brought on behalf of the next-of-kin of a person who suffers an injury due to the negligence of another which results in death.  Minnesota Statute 573.02 is the controlling statute concerning a wrongful death action. 

The next-of-kin can bring an action to recover damages for the amount the jury deems fair and just in reference to the pecuniary loss resulting from the death, and shall be for the exclusive benefit of the surviving spouse and next of kin, proportionate to the pecuniary loss severally suffered by the death. The court then determines the proportionate pecuniary loss of the persons entitled to the recovery and orders distribution accordingly. Funeral expenses and any demand for the support of the decedent allowed by the court having jurisdiction of the action, are first deducted and paid. Punitive damages may be awarded as provided in section 549.20.         

Wrongful Death Pecuniary Loss

The statute does not define pecuniary loss. however, that pecuniary loss includes loss of “advice, counsel, and loss of companionship.” Jones v. Fisher, 309 N.W.2d 726, 730 (Minn.1981); see also Gravley v. Sea Gull Marine, Inc., 269 N.W.2d 896, 901 (Minn.1978) (noting that pecuniary loss includes “loss of advice, comfort, assistance, and protection”). The sample jury instructions state that “[p]ecuniary loss is financial loss, but also includes loss of counsel, guidance and aid.” 4 Minn. Dist. Judges Ass’n, Minnesota Practice-Jury Instruction Guides, Civil, CIVJIG 45.45 (5th ed.2006).

Wrongful DeathA wrongful death action in Minnesota does not include many of the damages most family members seek the most, including: pain, suffering, grief, and emotional distress.  Punitive damages are only awarded in Minnesota “upon clear and convincing evidence that the acts of the defendant show deliberate disregard for the rights or safety of others”.  549.20.   

Many wrongful death cases in a nursing home setting are the result of a preventable event such as fall injury with resulting fractures or a subdural hematoma, or from some form of infection, such as urinary tract infections, or septic pressure sores, or wounds.

If a loved one has suffered from an untimely death due to the neglect of a health care professional or facility, contact Attorney Kenneth L. LaBore to hold the negligent party accountable.  Mr. LaBore can be reached for a free consultation by email at KLaBore@MNnursinghomeneglect.com or by phone at 612-743-9048 or toll free at 1-888-452-6589.

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What is a MRSA Infection?

mrsa190

Scanning electron micrograph (SEM) depicting numerous clumps of MRSA bacteria. Credit: Centers for Disease Control and Prevention, NIAID.

MRSA Infection Statistics

In 2010, encouraging results from a CDC study published in the Journal of the American Medical Association showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 28% from 2005 through 2008. Decreases in infection rates were even bigger for patients with bloodstream infections.

In addition, the study showed a 17% drop in invasive MRSA infections that were diagnosed before hospital admissions (community onset) in people with recent exposures to healthcare settings. This study (or report) complements data from the National Healthcare Safety Network (NHSN) that found rates of MRSA bloodstream infections occurring in hospitalized patients fell nearly 50% from 1997 to 2007.

Currently the CDC believes about one of three people carry staph in their nose, and 2 in 100 carry MRSA.

MRSA Infection Topics Provided by the Center for Disease Control – Source CDC

hand hygienePrevention

Personal, Healthcare Settings, Athletics, Schools, with advice on environmental cleaning and disinfecting for MRSA

Who is at risk for MRSA? – including nursing homes, assisted living, memory care, group homes and other environments.

medical bagTreatment

What To Do, Clinical Information…

petree dishDiagnosis & Testing

Clinical Diagnosis, Laboratory Information…

line chartStatistics

Statistical Data…

thermometerSymptoms

Skin Infections, Photos, …

peoplePeople at Risk

Personal, Healthcare Settings, Athletics, Schools…

compondsCauses

How MRSA is Spread, Origins…

cleaning productsEnvironmental Cleaning

Disinfectants, Laundry, Athletic Facilities…

booksEducational Resources

General education & Athletic posters…

According to the National Institute of Allergy and Infectious Disease, NIAID – MRSA is largely a hospital-acquired infection, in fact, one of the most common. Recently, however, new strains have emerged in the community that are capable of causing severe infections in otherwise healthy people.

If you or a loved one has suffered an injury from Staph, C-Diff, MRSA, VRE, CRE or any other infectious disease or other neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact Attorney Kenneth L. LaBore, directly please send an email to KLaBore@MNnursinghomeneglect.com, or call Ken at 612-743-9048 or call him at his direct toll free number 1-888-452-6589.

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What are VRE Infections?

PHIL Image 209

VRE Bacterium

VRE Infections – VRE also known as Vancomycin-Resistant Enterococcus (VRE) Infection which is a antimicrobial-resistant bacteria that are resistant to vancomycin, the drug often used to treat infections caused by enterococci.  According to the Centers for Disease Control and Prevention CDC , enteroccocci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Most vancomycin-resistant Enterococci infections occur in hospitals.

VRE Infections- What are the two types of vancomycin resistance in enterococci?

According to the CDC – there are the two types of VRE infections vancomycin resistance in enterococci. The first type is intrinsic resistance. Isolates of Enterococcus gallinarum and E. casseliflavus/E. flavescens demonstrate an inherent, low-level resistance to vancomycin. The second type of vancomycin resistance in enterococci is acquired resistance. Enterococci can become resistant to vancomycin by acquisition of genetic information from another organism. Most commonly, this resistance is seen in E. faecium and E. faecalis, but also has been recognized in E. raffinosus, E. avium, E. durans, and several other enterococcal species. According to National Institute of Allergy and Infectious Diseases, Vancomycin-Resistant Enterococci (VRE) – Enterococci are bacteria that are commonly found in the human digestive tract and female genital tract, but do not pose a threat to healthy people. Infections occur more commonly in people who are in hospitals or other healthcare facilities and who may be more susceptible to infection. Healthcare providers commonly use the antibiotic vancomycin to treat infections, but upon exposure, some bacteria will develop or acquire resistance to vancomycin.

If you or a loved one has suffered an injury from Staph, C-Diff, MRSA, VRE, CRE or any other infectious disease or other neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact  Attorney Kenneth L. LaBore, directly please send an email to KLaBore@MNnursinghomeneglect.com, or call Ken at 612-743-9048 or call him at his direct toll free number 1-888-452-6589.

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PHIL 3876 lores C Diff Infection in Nursing Home

Picture of Clostridium difficile (C. difficile, or C. diff).

According to a WebMD article, Digestive Disorders Health Center – the average human digestive tract is home to as many as 1,000 species of microorganisms. Most of them are harmless — or even helpful — under normal circumstances. But when something upsets the balance of these organisms in your gut, otherwise harmless bacteria can grow out of control and make you sick.

One of the worst offenders is a bacterium called Clostridium difficile (C. difficile, or C. diff). As the bacteria overgrow they release toxins that attack the lining of the intestines, causing a condition called Clostridium difficile colitis. Though relatively rare compared to other intestinal bacteria, C. diff is one of the most important causes of infectious diarrhea in the U.S.

Clostridium difficile / C- Diff infections are caused by the germ C. difficile – remains at  historically high levels. C. difficile causes diarrhea linked to 14,000 American deaths each year. Those most at risk are people, especially older  adults, who take antibiotics and also get medical care. CDC provides guidelines and tools to the healthcare community to help prevent Clostridium difficile infections as well as provides resources to help the public safeguard their own health.

According to WebMD, In addition to prescribed medications, treatment may include:

  • Probiotics. Available in most drug and health food stores without a prescription, probiotics are “good” bacteria that colonize in the gut and may help keep C. diff. infection from recurring if taken along with prescribed medicines.
  • Fluids. Drinking plenty of water and other fluids or getting intravenous fluids can help guard against dehydration from diarrhea.

C Diff in Nursing Home Facilities and Other Settings, Source CDC

Frequently Asked Questions C-Diff Infections – Source CDC

Stopping C. Difficile Infections – Making Health Care Safer – Source CDC

C Diff in Nursing Home Facilities and Other Settings – Source CDC

If you or a loved one has suffered an injury from MRSA, C-Diff, Staph, VRE infections or any other infectious disease or other neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact Attorney Kenneth L. LaBore, directly please send an email to KLaBore@mnnursinghomeneglect.com, or call Ken at 612-743-9048 or call him at his direct toll free number 1-888-452-6589.

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Elder Sexual Abuse

Elder Sexual Abuse

Nursing Homes Have a Legal Duty to Prevent Elder Sexual Abuse

Sexual Abuse of the Elderly is one of the most understudied aspects of elder mistreatment. An National Institute of Justice, NIJ-sponsored study that examined elder sexual abuse found that: [1]

  • Elderly sexual assault victims were not routinely evaluated to assess the psychological effects of an assault.
  • The older the victim, the less likelihood that the offender would be convicted of sexual abuse.
  • Perpetrators were more likely to be charged with a crime if victims exhibited signs of physical trauma.
  • Victims in assisted living situations faced a lower likelihood than those living independently that charges would be brought and the assailant found guilty.

Abuse in Nursing Homes and other Long Term Care Facilities

The National Center on Elder Abuse – Administration on Aging, elder abuse occurs in community settings, such as private homes, as well as institutional settings like nursing homes and other types of long term care facilities. 3.2 million Americans resided in nursing homes during 2008. In 2009, the National Center for Assisted Living reported that over 900,000 people nationwide lived in assisted living settings.

Below is a sampling of research findings relating to abuse in long term care facilities:

  • 7% of all complaints regarding institutional facilities reported to long term care Ombudsmen were complaints of abuse, neglect, or exploitation.
  • In 2000, one study interviewing 2,000 nursing home residents reported that 44% said they had been abused and 95% said they had been neglected or seen another resident neglected.
  • A May 2008 study conducted by the U.S. General Accountability Office revealed that state surveys understate problems in licensed facilities: 70% of state surveys miss at least one deficiency and 15% of surveys miss actual harm and immediate jeopardy of a nursing home resident.

The National Center on Elder Abuse (NCEA) defines elderly sexual abuse as “non-consensual sexual contact of any kind with an elderly person” or “[s]exual contact with any person incapable of giving consent.” This definition includes “unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.”

The NCEA synthesizes pertinent research on topics related to elder abuse, neglect, and exploitation into summary research briefs.  Research briefs released in 2012 include:

If you are concerned about a vulnerable adult who is the victim of sexual abuse or other form of neglect contact Attorney Kenneth LaBore for a free consultation at 612-743-9048 or at 1-888-452-6589 or by email at KLaBore@MNnursinghomeneglect.com

 

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Here is some additional information about urinary infections:

UTI Event Reporting – Center for Disease Control and Prevention, CDC, Training Presentation –  Produced by National Healthcare Safety Network.

Urinary Tract Infection (UTI) Event for Long-term Care Facilities, Center for Disease Control and Prevention, CDC – This has excellent protocols for determining the existence of urinary tract infections.

medical report with tubes of blood and urine

Nosocomial Infections What Geriatricians Should Know – American Geriatrics.

Candidiasis Yeast Infection Symptoms and Signs – emedicinehealth.com.

Catheter Urinary Infections

CAUTI Baseline Prevention Practices Assessment Tool – Center for Disease Control and Prevention, CDC.

CAUTI Tool Kit  – Center for Disease Control and Prevention, CDC,

Healthcare-associated Infections (HAIs) – Center for Disease Control and Prevention, CDC – Deals with Prevention of Healthcare Infections.

FAQs about Catheter-Associated Urinary Tract Infections – Center for Disease Control and Prevention, CDC.

Urinary Tract Infections: Indwelling (Foley) Catheter – Northwest Regional Spinal Cord Injury System, University of Washington Rehabilitation Medicine.

Catheter-Associated Urinary Tract Infection – Institute for Healthcare Improvement.

Management of Catheter-Associated Urinary Tract Infection (CAUTI), Barbara W. Trautner, MD, PhD.

Catheter-Associated Urinary Tract Infections (CAUTI) – Health Care-Associated Infections (HAI), The Joint Commission.

If you would like information about elder abuse or neglect including a urinary tract infection, UTI, contact attorney Kenneth LaBore at 612-743-9048 or by email at: : klabore@MNnursinghomeneglect.com

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Catheter Use - Preventable Urinary Tract Infections UTIs

Catheter Use – Preventable Urinary Tract Infections UTIs

Catheter Use – Only When Clinically Necessary

According to MedlinePlus, a urinary tract infection, or “UTI,” is an infection that can occur in the kidneys, in the tubes that take urine from the kidneys to the bladder, or in the bladder.  An indwelling catheter (tube) in your bladder – “Indwelling” means inside the body. This catheter drains urine from the bladder into a bag outside the body.

  • When you have an indwelling urinary catheter, you are more likely to develop a UTI. These infections are more likely if you have the catheter in place for a long time.
  • Bacteria cause most UTIs that are related to having a catheter. A fungus called Candida [Yeast Infection] can also cause UTIs.

According the CDC – Catheter-Associated Urinary Tract Infection – if you have a urinary catheter, germs can travel along the catheter and cause an infection in your bladder or your kidney; in that case it is called a catheter-associated urinary tract infection (or “CA-UTI”). A urinary catheter is a thin tube placed in the bladder to drain urine. Urine drains through the tube into a bag that collects the urine. A urinary catheter may be used:

  • If you are not able to urinate on your own
  • To measure the amount of urine that you make, for example, during intensive care
  • During and after some types of surgery
  • During some tests of the kidneys and bladder

People with urinary catheters have a much higher chance of getting a urinary tract infection than people who don’t have a catheter.

Nursing home residents often require the indwelling catheter use, however many others are given a catheter in short for the convenience of the staff in that they need not transfer and toilet the resident as often.  Beyond the violation to the body and associated pain and discomfort and the limiting of movement and freedom for the resident, the catheter brings an increased risk of urinary tract infection due to the foreign body being placed into the body.

Federal regulations also require that each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.

(d) Urinary Incontinence. Based on the resident’s comprehensive assessment, the facility must ensure that—

(1) A resident who enters the facility without an indwelling catheter is not catheterized unless the resident’s clinical condition demonstrates that catheterization was necessary; and
(2) A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.

Catheter careCenter for Disease Control and Prevention

  • Healthcare providers clean their hands by washing them with soap and water or using an alcohol-based hand rub before and after touching your catheter.
  • Avoid disconnecting the catheter and drain tube. This helps to prevent germs from getting into the catheter tube.
  • The catheter is secured to the leg to prevent pulling on the catheter.
  • Avoid twisting or kinking the catheter.
  • Keep the bag lower than the bladder to prevent urine from backflowing to the bladder.
  • Empty the bag regularly. The drainage spout should not touch anything while emptying the bag.
  • If you do not see your providers clean their hands, please ask them to do so.

According to an article in NCBI, there has been a recent upsurge of interest in prevention of CAUTI and a proliferation of guidelines in this area. Social changes in US government reimbursement to hospitals and public reporting of hospital-acquired infections may underlie this interest. The awareness that CAUTI and catheter-associated asymptomatic bacteriuria (CA-ASB) are distinct conditions is increasing, but unnecessary treatment of ASB remains quite prevalent. The focus in recent CAUTI literature is on prevention, often through strategies to minimize urinary catheter use. Very little new evidence is available to guide diagnosis and treatment strategies.

Here is some additional information about urinary infections

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Urinary Tract Infections UTI and  bladder infections are one of the most common issues which most residents in nursing homes and other care facilities need to deal with.  Like most forms of elder neglect UTIs are preventable with proper care and training on infectious disease.   Urinary infections can occur from several sources including indwelling catheter use or a failure to follow infectious disease protocols.

The federal regulations are clear that a resident who enters a nursing home without a urinary tract infection shall not develop one unless clinically unavoidable.

medical report with tubes of blood and urineAccording to the Center for Disease Control, CDC, in an article titled: Urinary Tract Infection (UTI) Event for Long-term Care Facilities the urinary tract is one of the most common sites of healthcare-associated infections, accounting for 20-30% of infections reported by long-term care facilities (LTCFs)[nursing homes]. In the LTC [nursing home] resident, risk factors for developing bacteriuria and UTI include age-related changes to the genitourinary tract, comorbid conditions resulting in neurogenic bladder, and instrumentation required to manage bladder voiding. The point prevalence of asymptomatic bacteriuria in LTC residents can range from 25-50%. Although the incidence of symptomatic UTI is lower, it still comprises a significant proportion of infections manifesting in LTCFs [nursing homes] and results in a large amount of antibiotic use.

Urinary tract infections (UTI) are defined using a combination of clinical signs and symptoms and laboratory criteria.

Symptomatic UTI (SUTI) events occur when the resident manifests signs and symptoms such as acute dysuria, new and/or marked increase in urinary frequency, suprapubic tenderness, etc. which localize the infection to the urinary tract. These events can occur in residents without urinary devices or managed with urinary devices other than indwelling urinary catheters, such as suprapubic catheters, straight in-and-out catheters and condom catheters.

Catheter-associated SUTIs (CA-SUTI) events occur when a resident develops signs and symptoms localizing to the urinary tract while having an indwelling urinary catheter in place or removed within the 2 calendar days prior to the date of event.

Federal regulations also require that each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. Based on the resident’s comprehensive assessment, the facility must ensure that a resident who enters the facility without an indwelling catheter is not catheterized unless the resident’s clinical condition demonstrates that catheterization was necessary; and a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.

If you or a loved one suffered from a urinary infection or other form of neglect in a nursing home or other care facility contact Attorney Kenneth LaBore for a free consultation.  Mr. LaBore can be reached by phone at 612-743-9048 or toll free at 1-888-452-6589 or by email: KLaBore@MNnursinghomeneglect.com.

Here is some additional information about urinary infections.

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Medication Overdose of Nursing Home Residents

Medication overdose through either inattention or other medication error is a serious problem in nursing homes, hospitals and other healthcare facilities.

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NIHSeniorHealth
CLICK HERE FOR VIDEO Taking Medicine Safely

According to NIHSeniorHealth: Older Adults and Medications – Older people as a group tend to have more long-term, chronic illnesses such as arthritis, diabetes, high blood pressure and heart disease than any other age group. Because they may have a number of health problems or issues at the same time, it is common for older people to take many different drugs. Here are some tips on how to take medicines safely and get the best results from them.

NIHSeniorHealth suggests – if your doctor prescribes a medication for your condition, try to find out as much about it as you can, including how to take it properly. Ask the following questions and write down the answers before leaving the doctor’s office.

  • What is the name of the condition this medicine will treat?
  • What is the name of the medicine?
  • How does it treat my condition?
  • What is the name of its active ingredient?
  • Did you check that it doesn’t contain anything I’m allergic to?
  • How long will it take to work?
  • How should I store the medication?
  • Does it need to be refrigerated?
  • Can the pharmacist substitute a less expensive, generic form of the medicine?

Find Out How to Take the Medication

Ask your doctor, pharmacist, or nurse about the right way to take any medicine before you start to use it. Ask questions when you don’t know the meaning of a word, or when instructions aren’t clear. Here are some specific questions to ask.

  • Should I take it as needed or on a schedule?
  • Should I take it at a certain time of day?
  • How much should I take each time?
  • Do I need to take it with food?
  • May I drink alcohol while on this medication?
  • How long will I have to take it?

Ask [Your Doctor] What to Expect

  • How will I feel once I start taking this medicine?
  • How will I know if this medicine is working?
  • If I forget to take it, what should I do?
  • What side effects might I expect?
  • Should I report them?
  • Can this medicine interact with other prescription and over-the-counter medicines — including herbal and dietary supplements — that I am taking now?

Healthinaging.org provides information from healthcare professionals who specialize in the care of older adults, in an article titled: Avoiding Overmedication and Harmful Drug Reactions – as you grow older, you are more likely to develop long-term health conditions that require taking multiple medications. Many older people also take over-the-counter (OTC) medications, vitamins, or supplements. As a result, older adults have a higher risk of overmedication and unwanted drug reactions (adverse drug events).

If you are interested in a free consultation with an experienced attorney who has handled numerous nursing home medication error cases call: Kenneth L. LaBore at 612-743-9048 or toll free at 1-888-452-6589 at by email at KLaBore@MNnursinghomeneglect.com.

 

 

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1028441_27922878Medication given to wrong patient or resident in a nursing home is one of many types of medication errors which occur in nursing home and other elder care facilities.  Unnecessary medication is another form of medication error which also is a frequent violation of federal statute.  A great resource for determining the risks associated with a medication see the FDA Medication Guide. 

42 CFR 483.25 (l) Unnecessary drugs —(1) General. Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used:

(i) In excessive dose (including duplicate drug therapy); or

(ii) For excessive duration; or

(iii) Without adequate monitoring; or

(iv) Without adequate indications for its use; or

(v) In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or

(vi) Any combinations of the reasons above.

(m) Medication Errors. The facility must ensure that—

(1) It is free of medication error rates of five percent or greater; and

(2) Residents are free of any significant medication errors.

According to the American Geriatric Society article titled: American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS).

The American Geriatrics Society Updated Beers Criteria (AGS, 2012). The AGS Updated Beers Criteria include three main categories: (1) potentially inappropriate medications and classes to avoid in older adults; (2) potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate; and (3) medications to be used with caution in older adults.   The target population was adults over 65 in all ambulatory and institutional care settings.

The American Geriatric Society also produce valuable articles titled:

Using Medications Safely – For Elders

Avoiding Overmedication and Harmful Drug Reactions

Ten Medications Older Adults Should Avoid or Use with Caution

Medication errors, including medication given to wrong patient and medication overdose can lead to or be a contributing factor in several other forms of elder abuse and neglect including, falls, pressure sores, infections, wandering, choking and other types of injury and in some cases wrongful death.

Each resident in a nursing home must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. 42.CFR 483.

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Unnecessary Drugs Given to Residents

It is common for nursing homes and other to give residents unnecessary drugs medications, including antipsychotic drugs and psychotropic medications, this is often done for the convenience of the staff and caregivers, rather than for the benefit of the resident.  It is my experience that heavily medicated residents are less active and require less supervision and interaction.

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Federal Regulations establish guidelines on medication errors and measures which must be followed to reduce the likelihood of errors – 42 CFR 483.25

(l) Unnecessary drugs —(1) General. Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used:

(i) In excessive dose (including duplicate drug therapy); or

(ii) For excessive duration; or

(iii) Without adequate monitoring; or

(iv) Without adequate indications for its use; or

(v) In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or

(vi) Any combinations of the reasons above.

(2) Antipsychotic Drugs. Based on a comprehensive assessment of a resident, the facility must ensure that—

(i) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and

(ii) Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.

According to a New England Journal of Medicine, 2005, article, Risk of Death in Elderly Users of Conventional vs. Atypical Antipsychotic Medications: Conventional antipsychotic medications were associated with a significantly higher adjusted risk of death than were atypical antipsychotic medications at all intervals studied (≤180 days: relative risk, 1.37; 95 percent confidence interval, 1.27 to 1.49; <40 days: relative risk, 1.56; 95 percent confidence interval, 1.37 to 1.78; 40 to 79 days: relative risk, 1.37; 95 percent confidence interval, 1.19 to 1.59; and 80 to 180 days: relative risk, 1.27; 95 percent confidence interval, 1.14 to 1.41) and in all subgroups defined according to the presence or absence of dementia or nursing home residency. The greatest increases in risk occurred soon after therapy was initiated and with higher dosages of conventional antipsychotic medications. Increased risks associated with conventional as compared with atypical antipsychotic medications persisted in confirmatory analyses performed with the use of propensity-score adjustment and instrumental-variable estimation.

Improving Dementia Care and Reducing Unnecessary Antipsychotic Medications in Nursing Homes, an online training for nursing home staff.

If you or someone you love has been the victim of a medication overdose, given contraindicated or unnecessary drug or wrong medication, or some other form of medication error, contact an experienced nursing home abuse and neglect attorney for a free consultation.  Attorney Kenneth L. LaBore can be reached by phone at 612-743-9048 or toll free at 1-888-452-6589, and by email at KLaBore@MNnursinghomeneglect.com.

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Medication Errors in Nursing Homes Are Preventable

Nursing homes have a legal duty to ensure that residents are free of any significant medication error.  Yet, medication errors are one of the most common forms of preventable neglect found in nursing homes and other care facilities.  According to the U.S. Food and Drug Administration website provides several valuable resources on how to prevent medication errors:

1213599_18334934According to the Center for Disease Control, CDC:

Adverse drug events (ADEs) are a serious public health problem. It is estimated that:

  • 82% of American adults take at least one medication and 29% take five or more [1]
  • 700,000 emergency department visits and 120,000 hospitalizations are due to ADEs annually [2]:
  • $3.5 billion is spent on extra medical costs of ADEs annually [3];
  • At least 40% of costs of ambulatory (non-hospital settings) ADEs are estimated to be preventable [3]

The numbers of adverse drug events will likely grow due to:

  • Development of new medications
  • Discovery of new uses for older medications
  • Aging American population
  • Increase in the use of medications for disease prevention
  • Increased coverage for prescription medications

Medication Errors FDA – Medication Guides, Medication Guides are paper handouts that come with many prescription medicines. The guides address issues that are specific to particular drugs and drug classes, and they contain FDA-approved information that can help patients avoid serious adverse events. FDA requires that Medication Guides be issued with certain prescribed drugs and biological products when the Agency determines that:

  • certain information is necessary to prevent serious adverse effects
  • patient decision-making should be informed by information about a known serious side effect with a product, or
  • patient adherence to directions for the use of a product are essential to its effectiveness.

Federal Regulations Pertaining to the Prevention of Nursing Home Medication Errors

FDA Drug Info Rounds – Medication Errors

Guidance for Industry – Safety Considerations for Product Design to Minimize Medication Errors

Federal Regulations establish guidelines on medication errors and measures which must be followed to reduce the likelihood of errors – 42 CFR 483.25

(l) Unnecessary drugs —(1) General. Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used:

(i) In excessive dose (including duplicate drug therapy); or
(ii) For excessive duration; or
(iii) Without adequate monitoring; or
(iv) Without adequate indications for its use; or
(v) In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or
(vi) Any combinations of the reasons above.

(2) Antipsychotic Drugs. Based on a comprehensive assessment of a resident, the facility must ensure that—

(i) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and
(ii) Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.

(m) Medication Errors. The facility must ensure that—

(1) It is free of medication error rates of five percent or greater; and
(2) Residents are free of any significant medication errors.

Medication Theft is also a Preventable Medication Error

In addition to the medication errors based on necessity, dosage, and other mistakes, it is a crime and serious neglect for employees of the nursing homes or other care facilities to steal the medications intended for the resident.  These medications are usually narcotic pain medications stolen by the staff to either resell on the black market to take themselves.

If you or someone you love has been the victim of a medication overdose, given contraindicated or unnecessary drugs or wrong medication, or some other form of medication error, contact an experienced nursing home abuse and neglect attorney for a free consultation.  Attorney Kenneth L. LaBore can be reached by phone at 612-743-9048 or toll free at 1-888-452-6589, and by email at KLaBore@MNnursinghomeneglect.com.

 

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What is a Medication Guide?

According to the U.S.Food and Drug Administration – Medication Guides are paper handouts that come with many prescription medicines. 

FDA requires that Medication Guides be issued with certain prescribed drugs and biological products when the Agency determines that:

  • certain information is necessary to prevent serious adverse effects
  • patient decision-making should be informed by information about a known serious side effect with a product, or
  • patient adherence to directions for the use of a product are essential to its effectiveness.

For a Detailed Explanation of Medication Guides see: Guidance – Medication Guides Distribution Requirements and Inclusion Risk Evaluation

 

Medication Guide, Index and Links to Medications

Medication Guides are available from the FDA website for these products:

*biologic or drug/biologic combination

  • AnoroEllipta (Umeclidinium; Vilanterol) [2013 version]
  • Abilify (aripiprazole) [2014 version]
  • UpdatedAbilify Maintena (aripiprazole) [2014 version]
  • Absorica (isotrentinoin) [2014 version]
  • Abstral (fentanyl) [2013 version]
  • Aciphex (rabeprazole sodium) [2012 version]
  • Accutane (isotretinoin) [2010 version]
  • Actemra* (tocilizumab) [2013 version]
  • Actiq (fentanyl citrate) [2011 version]
  • Actonel (risedronate sodium) [2013 version]
  • Actonel with Calcium (risedronate sodium and calcium carbonate) [2013 version]
  • Actoplus Met (metformin hydrochloride and pioglitazone hydrochloride) [2012 version]
  •  Actoplus Met XR (metformin hydrochloride and pioglitazone hydrochloride) [2013 version]
  •  Actos (pioglitazone hydrchloride) [2013 version]
  • Adasuve (loxapine) [2012 version]
  • Adderall XR (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate) [2013 version]
  • Adempas (riociguat) [2013 version]
  • Advair Diskus (fluticasone propionate and salmeterol xinafoate) [4/2014 version]
  • Advair HFA (fluticasone propionate and salmeterol xinafoate) [2012 version]
  • Ambien (zolpidem tartrate) [2013 version]
  • Ambien CR (zolpidem tartrate) [2013 version]
  • Amevive* (alefacept) [2012 version]
  • Ampyra (dalfampridine) [2013 version]
  • Anafranil (clomipramine hydrochloride) [2012 version]
  • Anaprox (naproxen sodium) [2013 version]
  • Androgel (1%) (testosterone) [2014 version]
  • Androgel (1.62%) (testosterone) [2014 version]
  • Ansaid (flurbiprofen) [2010 version]
  • Aplenzin (bupropion hydrobromide [2012 version]
  • Aranesp* (darbepoetin alfa) [2012 version)
  • Arcapta (indacaterol maleate) [2012 version]
  • UpdatedArthrotec (diclofenac sodium) [2014 version]
  • Astagraf XL (tacrolimus) [2014 version]
  • Atelvia (risedronate sodium) [2013 version]
  • Aubagio (teriflunomide) [2012 version]
  • Avandamet (metformin hydrochloride and rosiglitazone maleate) [5/2014 version]
  • Avandaryl (glimepiride and rosiglitazone maleate) [5/2014 version]
  • Avandia (rosiglitazone maleate) [5/2014 version]
  • Aveed (testosterone undecanoate) [2014 version]
  • Avelox (moxifloxacin) [2013 version]
  • Avinza (morphine sulfate) [2014 version]
  • Avonex* (interferon beta-1a) [2012 version]
  • Axiron (testosterone) [2014 version]
  • Banzel (rufinamide) [2011 version]
  • Benlysta (belimumab) [2013 version]
  • Betaseron*(interferon beta-1b) [2012 version]
  • Binosto (alendronate sodium) [2013 version]
  • Boniva (ibandronate sodium) Injection [2013 version]
  • Boniva (ibandronate sodium) Tablets [2013 version]
  • Botox* (onabotulinumtoxinA) [2013 version]
  • Breo Ellipta (fluticasone furoate and vilanterol) [2013 version]
  • Brilinta (ticagrelor) [2013 version]
  • Brintellix (vortioxetine) [2014 version]
  • Brisdelle (paroxetine) [2013 version]
  • Brovana (arformoterol tartrate) [2014 version]
  • Bunavail (Buprenorphine and naloxone) Buccal Film (6/2014)
  • Butrans (buprenorphine) [2014 version]
  • Bydureon (exenatide) [2014 version]
  • Byetta (exenatide) [2011 version]
  • Cambia (diclofenac) [2009 version]
  • Caprelsa (vandetanib) [3/2014 version]
  • Carbatrol (carbamazepine) [2013 version]
  • Cataflam (diclofenac potassium) [2011 version]
  • Celebrex (celecoxib) [2011 version]
  • Celexa (citalopram hydrobromide) [4/2014 version]
  • Cellcept (mycophenolate mofetil) [2013 version]
  • Celontin (methsuximide) [2010 version]
  • UpdatedChantix (varenicline tartrate) [9/2014 version]
  • Cimzia* (certolizumab pegol) [2013 version]
  • Cipro (ciprofloxacin) [2013 version]
  • Clinoril (sulindac) [2010 version]
  • Codeine Sulfate oral solution [2013 version]
  • Colcrys (colchicine) [2011 version]
  • Combunox (oxycodone hydrochloride and ibuprofen) [2010 version]
  • Concerta (methylphenidate hydrochloride) [2013 version]
  • Copegus (ribavirin) [2011 version]
  • Cordarone (amiodarone hydrochloride) [2011 version]
  • Coumadin (warfarin sodium) [2011 version]
  • Creon (pancrelipase) [2012 version]
  • Cymbalta (duloxetine hydrochloride) [2014 version)]
  • Daliresp (roflumilast) [2013 version]
  • Dalmane (flurazepam hydrochloride) [2009 version]
  • Darvocet (acetaminophen and propoxyphene napsylate) [2009 version]
  • Darvon (propoxyphene hydrochloride) [2009 version]
  • Daypro Alta (oxaprozin potassium) [2007 version]
  • Daytrana (methylphenidate) [2013 version]
  • Depakene (valproic acid) [2014 version]
  • Depakote ER(divalproex sodium) [2014 version]
  • Desoxyn (methamphetamine hydrochloride) [2013 version]
  • Desvenlafaxine Extended Release Tablet(desvenlafaxine fumarate) [2014 version]
  • Dexedrine (dextroamphetamine sulfate) [2013 version]
  • Dexilant (dexlansoprazole) [2013 version]
  • Dilantin (phenytoin) [2011 version]
  • Dilantin-125 (phenytoin) [2014 version]
  • Dolophine (methadone hydrochloride) [2014 version]
  • Doral (quazepam) [2013 version]
  •  Duetact (glimepiride and pioglitazone) [2013 version]
  • Duexis (ibuprofen and famotidine) [2011 version]
  • Dulera (mometasone furoate and formoterol fumarate) [2013 version]
  • Duragesic (fentanyl) [2014 version]
  • Dysport* (abobotulinumtoxinA) [2012 version]
  • EC-Naprosyn (naproxen) [2013 version]
  • Edluar (zolpidem tartrate) [2013 version]
  • Effexor (venlafaxine hydrochloride) [2012 version]
  • Effexor XR (venlafaxine hydrochloride) [2012 version]
  • Effient (prasugrel) [2012 version]
  • Elidel Cream (pimecrolimus) [3/2014 version]
  • Eliquis (apixaban) [2014 version]
  • Embeda (morphine sulfate and naltrexone hydrochloride) [2014 version]
  • Emsam (selegeline transdermal system) [2007 version]
  • Enbrel* (etanercept) [2013 version]
  • Epogen* (epoetin alfa) [2012 version]
  • Epzicom (abacavir sulfate and lamivudine) [2012 version]
  • Equetro (carbamazepine) [2012 version]
  • Erivedge (vismodegib) [2012 version]
  • Estazolam [2008 version]
  • Evista (raloxifene hydrochloride) [2007 version]
  • Exalgo (hydromorphone hydrochloride) [2014 version]
  • Extavia* (interferon beta-1b) [2012 version]
  • Extraneal (icodextrin) [2010 version]
  • Exubera (insulin recombinant human) [2008 version]
  • Factive (gemifloxacin) [2013 version]
  • Felbatol (felbamate) [2011 version]
  • Feldene (piroxicam) [2010 version]
  • Fentora (fentanyl citrate) [2013 version]
  • Ferriprox (deferiprone) [2012 version]
  • Fetzima (levomilnacipran) [2014 version]
  • Flector (diclofenac epolamine) [2010 version]
  • Floxin (ofloxacin) [2011 version]
  • Fluoxetine (Fluoxetine) [2014 version]
  • Focalin (dexmethylphenidate hydrochloride) [2013 version]
  • Focalin XR (dexmethylphenidate hydrochloride) [2013 version]
  • Foradil Aerolizer (formoterol fumarate inhalation powder) [2012 version]
  • Foradil Certihaler (formoterol fumarate inhalation powder) [2010 version]
  • Forfivo XL (bupropion hydrochloride) [2014 version]
  • Forteo (teriparatide) [2013 version]
  • Fortesta (testosterone) [2014 version]
  • Fosamax (alendronate sodium) [2013 version]
  • Fosamax Plus D (alendronate sodium and cholecalciferol) [2013 version]
  • UpdatedFosrenol (lanthanum carbonate) [9/2014 version]
  • Fycompa (perampanel) [2014 version]
  • Gabitril (tiagabine) [2010 version]
  • Gattex (teduglutide [rDNA origin]) [2012 version]
  • Gilenya (fingolimid) [4/30/2014 version]
  • GoLytely (polyethylene glycol 3500, potassium chloride, sodium bicarbonate, sodium chloride, and sodium sulfate anhydrous) [2013 version]
  • Gralise (gabapentin) [2012 version]
  • UpdatedHalcion (triazolam) [9/2014 version]
  • HalfLytely and Bisacodyl Bowel Prep Kit (bisacodyl, polyethylene glycol 3500, potassium chloride, sodium bicarbonate, and sodium chloride) [2010 version]
  • Horizant (gabapentin enacarbil) [2013 version]
  • H.P. Acthar Gel (repository corticotropin) [2010 version]
  • Humira* (adalimumab) [2013 version]
  • Hydromorphone Hydrochloride ER [2014 version]
  • Incivek (telaprevir) [2013 version]
  • Iclusig (ponatinib) [2013 version]
  • Ilaris* (canakinumab) [2013 version]
  • Impavido (miltefosine) [2014 version]
  • Indocin (indomethacin) [2008 version]
  • Infergen* (interferon alfacon-1) [2013 version]
  • Intermezzo (zolpidem tartrate) [2013 version]
  •  Intron A* (interferon alfa-2b) [4/2014 version]
  • Invirase (saquinavir mesylate) [2012 version] 
  • Invokana (canagliflozin) [2013 version]
  • Janumet (metformin hydrochloride and sitagliptin phosphate) [2013 version]
  • Janumet XR (sitagliptin and metformin hydrochloride) [2014 version]
  • Januvia (sitagliptin phosphate) [2013 version]
  • Jentadueto (linagliptin and metformin hydrochloride) [2013 version]
  • Juvisync (sitagliptin and simvastatin) [2014 version]
  • Juxtapid (lomitapide) [2014 version]
  • Kadian (morphine sulfate) [2014 version]
  • Kalbitor* (ecallantide) [3/2014 version]
  • Kaletra Capsules (lopinavir and ritonavir) [2013 version]
  • Kaletra Tablets and Oral Solution (lopinavir and ritonavir) [2013 version]
  • Kazano (alogliptin and metformin hydrochloride) [2013 version]
  • Keppra (levetiracetam) [2013 version]
  • Keppra XR (levetiracetam) [2013 version]
  • Ketek (telithromycin) [2010 version]
  • the word new in a red boxKeytruda (pembrolizumab) [9/2014 version]
  • Khedezla (desvenlafaxine) [2013 version]
  • Klonopin (clonazepam) [2013 version]
  • Kombiglyze XR (metformin hydrochloride and saxagliptin) [2013 version]
  • Korlym (mifepristone) [2012 version]
  • Krystexxa* (pegloticase) [2012 version]
  • Kynamro (mipomersen sodium) [5/2014 version]
  • Lamictal (lamotrigine) [2013 version]
  • Lamictal XR (lamotrigine) [2013 version]
  • Lariam (mefloquine hydrochloride) [2009 version]
  • Latuda (lurasidone hydrochloride) [2013 version]
  • Lazanda (fentanyl citrate) [2011 version]
  • Letairis (ambrisentan) [2014 version]
  • Levaquin (levofloxacin) [2013 version]
  • Lexapro (escitalopram oxalate) [2012 version]
  • Limbitrol (chlordiazepoxide and amitriptyline) [2007 version]
  • Lindane Lotion (lindane) [2007 version]
  • Lindane Shampoo (lindane) [2007 version]
  • Linzess (linaclotide) [2013 version]
  • Lotronex (alosetron hydrochloride) [2010 version]
  • Lunesta (eszopiclone) [2014 version]
  • Luvox (fluvoxamine maleate) [2014 version]
  • Luvox CR (fluvoxamine maleate) [2014 version]
  • Lyrica (pregabalin) [2013 version]
  • Marplan (isocarboxazid) [2008 version]
  • Meridia (sibutramine hydrochloride) [2010 version]
  • Metadate CD (methylphenidate hydrochloride) [2013 version]
  • Methylin (methylphenidate)
  • Metoclopramide Oral Solution [2009 version]
  • Metozolv ODT (metoclopramide hydrochloride) [2011 version]
  • Mifeprex (mifepristone) [2009 version]
  • Mircera* (methoxy polyethylene glycol-epoetin beta) [2007 version]
  • the word new in a red boxMitigare (Colchicine) [9/2014 version]
  • Mobic (meloxicam) [2011 version]
  • Morphine Sulfate (morphine sulfate oral solution) [2011 version]
  • Motrin (ibuprofen) [2007 version]
  • Moviprep (polyethylene glycol 3350, sodium sulfate, sodium chloride, potassium chloride, sodium ascorbate, and ascorbic acid) [2013 version]
  • MS Contin (morphine sulfate) [2014 version]
  • Multaq (dronedarone) [2014 version]
  • Myfortic (mycophenolic acid) [2013 version]
  • Myobloc* (rimabotulinumtoxinB) [2009 version]
  • Mysoline (primidone) [2010 version]
  • Nalfon (fenoprofen calcium) [2009 version]
  • Naprelan (naproxen sodium) [2011 version]
  • Naprosyn (naproxen) [2013 version]
  • Nardil (phenelzine sulfate) [2007 version]
  • Nesina (alogliptin) [2013 version]
  • Neurontin (gabapentin) [2013 version]
  • Nexium (esomeprazole magnesium) [3/2014 version]
  • Nizoral (ketoconazole) [2014 version]
  • Nolvadex (tamoxifen) [2006 version]
  • Noroxin (norfloxacin) [2013 version]
  • Norpramin (desipramine hydrochloride) [2014 version]
  • Novantrone (mitoXantrone) [2012 version]
  • Nplate* (romiplostim) [2014 version]
  • NSAID (Nonsteroidal Anti-inflammatory Drugs) [2014 version]
  • Nucynta (tapentadol hydrochloride) [2012 version]
  • Nucynta ER (tapentadol) [2014 version]
  • Nulojix* (belatacept) [4/2014 version]
  • NuLytely (polyethylene glycol 3500, potassium chloride, sodium bicarbonate, and sodium chloride) [2013 version]
  • Nuvigil (armodafinil) [2013 version]
  • Oleptro (trazodone hydrochloride) [2014 version]
  • Omontys (peginesatide) [2012 version]
  • Onfi (clobazam) [2013 version]
  • Onglyza (saxagliptin hydrochloride) [2013 version]
  • Onsolis (fentanyl buccal soluble film) [2011 version]
  • Opana ER (oxymorphone hydrochloride) [2014 version]
  • Opsumit (macitentan) [2013 version]
  • Oseni (alogliptin and pioglitazone) [2013 version]
  • Osmoprep (sodium phosphate dibasic anhydrous and sodium phosphate monobasic monohydrate) [2012 version]
  • Oxtellar XR (oxcarbazepine) [2012 version]
  • Oxycodone Hydrochloride Oral Solution [2013 version]
  • OxyContin (oxycodone hydrochloride) [2014 version]
  • Pacerone (amiodarone hydrochloride) [2008 version]
  • Palladone (hydromorphone hydrochloride) [2004 version]
  • Pamelor (nortriptyline hydrochloride) [2012 version]
  • Pancreaze (pancrelipase) [2014 version]
  • Parnate (tranylcypromine sulfate) [2008 version]
  • Paxil (paroxetine hydrochloride) [2014 version]
  • Paxil CR (paroxetine hydrochloride) [2014 version]
  • Peganone (ethotoin) [2010 version]
  • UpdatedPegasys* (peginterferon alfa-2a) [2014 version]
  • Pegintron* (peginterferon alfa-2b) [2013 version]
  • PegIntron*/Rebetol Combo Pack (peginterferon alfa-2b and ribavirin) [2008 version]
  • Pennsaid (diclofenac sodium) [2014 version]
  • Perforomist (formoterol fumarate) [2012 version]
  • Pertzye (pancrelipase) [2012 version]
  • Pexeva (paroxetine mesylate) [2012 version]
  • Plavix (clopidogrel bisulfate) [2013 version]
  • Pomalyst (pomalidomide) [2014 version]
  • Ponstel (mefenamic acid) [2008 version]
  • Potiga (ezogabine) [2013 version]
  • Pradaxa (dabigatran etexilate mesylate) [4/2014 version]
  • Prepopik (sodium picosulfate, magnesium oxide and citric acid) [2012 version]
  • Prevacid (lansoprazole [2012 version]
  • Prevacid NapraPac (lansoprazole and naproxen) [2009 version]
  • Prilosec (omeprazole [3/2014 version]
  • Pristiq (desvenlafaxine succinate) [2014 version]
  • Procrit* (epoetin alfa) [2012 version]
  • Prolia* (denosumab) [2014 version]
  • Propylthiouracil [2010 version]
  • Promacta (eltrombopag) [2014 version]
  • Propulsid (cisapride) [2006 version]
  • Proquin XR (ciprofloxacin hydrochloride) [2011 version]
  • Protonix (pantoprazole sodium) [2013 version]
  • Protopic Ointment (tacrolimus) [2011 version]
  • Provigil (modafinil) [2010 version]
  • Prozac (fluoxetine hydrochloride) [2013 version]
  • UpdatedQsymia (phentermine and topiramate) [9/2014 version]
  • Qualaquin (quinine sulfate) [2014 version]
  • Qudexy XR (topiramate) [2014 version]
  • Quillivant XR (methylphenidate) [2013 version]
  • Rapamune (sirolimus) [2013 version]
  • Ravicti (glycerol phenylbutyrate) [2013 version]
  • Rebetol (ribavirin) [2013 version]
  • Rebif* (interferon beta-1a) [4/2014 version]
  • Reclast (zoledronic acid) [2013 version]
  • Reglan (metoclopramide hydrochloride) injection [2009 version]
  • Reglan (metoclopramide hydrochloride) tablets [2011 version]
  • Reglan ODT (metoclopramide hydrochloride) [2011 version]
  • the word new in a red boxRelistor (methylnaltrexone bromide) [9/2014 version]
  • Remeron (mirtazapine) [2014 version]
  • Remeron SolTab (mirtazapine) [2014 version]
  • Remicade* (infliximab) [2013 version]
  • Restoril (temazepam) [2010 version]
  • UpdatedRevlimid (lenalidomide) [2014 version]
  • Ribasphere (ribavirin) [2008 version]
  • Ritalin (methylphenidate hydrochloride) [2013 version]
  • Ritalin LA(methylphenidate hydrochloride) [2013 version]
  • Ritalin-SR (methylphenidate hydrochloride) [2013 version]
  • Rituxan* (rituximab) [2013 version]
  • Roferon-A* (interferon alfa-2a recombinant) [2008 version]
  • Rozerem (ramelteon) [2010 version]
  • Sabril (vigabatrin) [2013 version]
  • Samsca (tolvaptan) [2014 version]
  • Sarafem (fluoxetine hydrochloride) [2013 version]
  • Savella (milnacipran hydrochloride) [2013 version]
  • Selzentry (maraviroc) [3/2014 version]
  • Serevent Diskus (salmeterol xinafoate) [4/2014 version]
  • Seroquel (quetiapine fumarate) [2013 version]
  • Seroquel XR (quetiapine fumarate) [2013 version]
  • Signifor (pasireotide diaspartate) [2012 version]
  • Silenor (doxepin) [2010 version]
  • Simponi* (golimumab) [2014 version]
  • Simponi Aria* (golimumab) [2014 version]
  • Sinequan (doxepin hydrochloride) [2007 version]
  • Sirturo (bedaquiline) [2013 version]
  • Soliris* (eculizumab) [4/2014 version]
  • Soltamox (tamoxifen citrate) [2005 version]
  • Sonata (zaleplon) [2013 version]
  • Soriatane (acitretin) [2014 version]
  • Sotret (isotretinoin) [2006 version]
  • Stavzor (valproic acid) [2013 version]
  • Stelara* (ustekinumab) [2014 version]
  • Strattera (atomoxetine hydrochloride) [2014 version]
  • Suboxone (buprenorphine and naloxone) [4/2014 version]
  • Subsys (fentanyl) [2012 version]
  • Subutex (buprenorphine) [2011 version]
  • Suclear (sodium sulfate, potassium sulfate, magnesium sulfate, sodium chloride, sodium bicarbonate, and potassium chloride) [2013 version]
  • Suprep (sodium sulfate, potassium sulfate and magnesium sulfate) [2010 version]
  • Surmontil (trimipramine) [2014 version]
  • Sutent (sunitimib malate) [2013 version]
  • Sylatron (peginterferon alfa-2b) [2012 version]
  • Symbicort (budesonide and formoterol fumarate dihydrate) [2010 version]
  • Symbyax (fluoxetine hydrochloride and olanzapine) [2014 version]
  • Symlin (pramlintide acetate) [2007 version]
  • Synribo (omacetaxine mepesuccinate) [4/2014 version]
  • Tafinlar (dabrafenib) [2013 version]
  • Tapentadol see Nucynta
  • Targiniq ER (oxycodone hydrochloride and naloxone hydrochloride extended-release tablets) [2014 version]
  • Tasigna (nilotinib) [2013 version]
  • Tegretol and Tegretol XR (carbamazepine) [2014 version]
  • Testim (testosterone) [2014 version]
  • Testosterone Gel (Perrigo) [5/2014 version]
  • Testosterone Gel (Teva)[2014 version]
  • Thalomid (thalidomide) [2014 version]
  • Tikosyn (dofetilide) [2013 version]
  • Tofranil (imipramine hydrochloride) [2007 version]
  • Tofranil-PM (imipramine pamoate) [2012 version]
  • Tolectin (tolmetin sodium) [2008 version]
  • Topamax (topiramate) [3/2014 version]
  • Toradol (ketorolac tromethamine) [2013 version]
  • Tracleer (bosentan) [2012 version]
  • Tradjenta (linagliptin) [2013 version]
  • Tranxene (clorazepate dipotassium) [2010 version]
  • Treximet (naproxen sodium and sumatriptan succinate) [2012 version]
  • Tridione (trimethadione) [2012 version]
  • Trileptal (oxcarbazepine) [2011 version]
  • Trilipix (choline fenofibrate) [2012 version]
  • Trizivir (abacavir sulfate, lamivudine and zidovudine) [2012 version]
  • Trokendi XR (topiramate) [2013 version]
  • Truvada (emtricitabine and tenofovir disoproxil fumarate) [2013 version]
  • Tysabri* (natalizumab) [2013 version]
  • Tyzeka (telbivudine) [2013 version]
  • Ultresa (pancrelipase) [2012 version]
  • Valchlor (mechlorethamine) [2013 version]
  • Vandetanib see Caprelsa
  • Venlafaxine HCl ER (venlafaxine hydrochloride) [2014 version]
  • Vibativ (telavancin) [2013 version]
  • Vicoprofen (vicoprofen and ibuprofen) [2008 version]
  • Victoza (liraglutide) [2013 version]
  • Victrelis (boceprevir) [2014 version]
  • Videx (didanosine) [2011 version]
  • Videx EC (didanosine) [2011 version]
  • Viibryd (vilazodone hydrochloride) [4/2014 version]
  • Vimovo (esomeprazole magnesium and naproxen) [3/2014 version]
  • Vimpat (lacosamide) [2013 version]
  • Viokace (pancrelipase) [2012 version]
  • Viramune and Viramune XR (nevirapine) [2014 version]
  • Visicol (sodium phosphate dybasic anhydrous and sodium phosphate monobasic monohydrate) [2013 version]
  • Vivactil (protriptyline hydrochloride) [2007 version]
  • Vivitrol (naltrexone) [2013 version]
  • Voltaren (diclofenac sodium) [2011 version]
  • Votrient (pazopanib hydrochloride) [2013 version]
  • Vyvanse (lisdexamfetamine dimesylate) [2014 version]
  • Wellbutrin (bupropion hydrochloride) [2014 version]
  • Wellbutrin SR (bupropion hydrochloride) [2013 version]
  • Wellbutrin XL (buproprion hydrochloride) [2011 version]
  • Xarelto (rivaroxaban) [March 2014 version]
  • Xartemis XR (oxycodone hydrochloride and acetaminophen) [2014 version]
  • Xeljanz (tofacitinib) [3/2014 version]
  • Xenazine (tetrabenazine) [2011 version]
  • Xeomin* (incobotulinumtoxinA) [2011 version]
  • Xiaflex* (collagenase clostridium histolyticum) [2013 version]
  • UpdatedXolair* (omalizumab) [9/2014 version]
  • Xyrem (sodium oxybate) [2012 version]
  • Yervoy* (ipilimumab) [2013 version]
  • Zarontin (ethosuximide) [2012 version]
  • Zegerid (omeprazole and sodium bicarbonate) [2014 version]
  • Zelboraf (vemurafenib) [2014 version]
  • Zenpep (pancrelipase) [2014 version]
  • Zerit (stavudine) [2011 version]
  • Ziagen (abacavir sulfate) [2012 version]
  • Zipsor (diclofenac potassium) [2009 version]
  • Zohydro ER (hydrocodone bitartrate) [2014 version]
  • Zoloft (sertraline hydrochloride) [2012 version]
  • Zolpidem (zolpidem tartrate) [2008 version]
  • Zolpimist (zolpidem tartrate) [2008 version]
  • Zonegran (zonisamide) [2012 version]
  • Zortress (everolimus) [2013 version]
  • Zorvolex (diclofenac) [2013 version]
  • Zubsolv (buprenorphine and naloxone) [2013 version]
  • Zyban (bupropion hydrochloride) [3/2014 version]
  • Zyprexa (olanzapine) [2013 version]
  • Zyprexa Relprevv (olanzapine) [2012 version]

 

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Infectious Diseases such as C-Diff, MRSA, VRE, Staph and others.

Nursing homes have to take reasonable measures to prevent residents from acquiring infectious diseases such as Staph, C-Diff, MRSA, VRE, CRE and others from other residents in the facility as well as the nursing staff. Although infectious disease is commonly found present in hospitals, nursing homes, assisted living and other elder care facilities, the potential adverse effects from exposure to infectious diseases is often over looked risks for elders. Seniors and  other vulnerable adults, some with compromised immune systems are susceptible to pathogens from other residents who share sources of air, food, water, and health care in a often crowded care facilities. The continual revolving traffic of family, residents, care givers, supplier and support staff are also a source for introduction of infection into the environment.1018465_escherichia_coli

Federal law requires that “each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care'”. 42 CFR 483.25.  The nursing home facility must establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection. 42 CFR 483.65.

 (a) Infection control program. The facility must establish an infection control program under which it—

(1) Investigates, controls, and prevents infections in the facility;

(2) Decides what procedures, such as isolation, should be applied to an individual resident; and

(3) Maintains a record of incidents and corrective actions related to infections.

(b) Preventing spread of infection. (1) When the infection control program determines that a resident needs isolation to prevent the spread of infection, the facility must isolate the resident.

(2) The facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease.

(3) The facility must require staff to wash their hands after each direct resident contact for which handwashing is indicated by accepted professional practice.

(c) Linens. Personnel must handle, store, process, and transport linens so as to prevent the spread of infection.

Infectious Disease Gloves

Some Common Infectious Diseases Present in Nursing Homes:

C-Diff –Clostridium difficile Infection, (source CDC) – people getting medical care can catch serious infections called healthcare-associated infections (HAIs). While most types of HAIs are declining, one – caused by the germ C. difficile – remains at historically high levels. C. difficile causes diarrhea linked to 14,000 American deaths each year.

Those most at risk are people, especially older adults, who take antibiotics and also get medical care. MRSA – Methicillin-resistant Staphylococcus aureus (MRSA) in both healthcare and community settings continues to be a high priority for the CDC. VRE – Vancomycin-resistant Enterococci are specific types of antimicrobial-resistant bacteria that are resistant to vancomycin, the drug often used to treat infections caused by enterococci. CRE – Carbapenem-resistant Enterobacteriaceae, are a family of germs that are difficult to treat because they have high levels of resistance to antibiotics. Staph – Staphylococcus aureus is a common bacterium found on the skin and in the noses of up to 25% of healthy people and animals. Staphylococcus aureus is important because it has the ability to make seven different toxins that are frequently responsible for food poisoning.

Infection Prevention and Control, from Joint Commission

If you or a loved one has suffered an injury from Staph, C-Diff, MRSA, VRE, CRE or any other infectious disease or other neglect or abuse in a nursing home or other care facility that serves the elderly in Minnesota please contact Attorney Kenneth L. LaBore, directly please send an email to KLaBore@mnnursinghomeneglect.com, or call Ken at 612-743-9048 or call him at his direct toll free number 1-888-452-6589.

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Nursing Home Neglect Wrongful Death Claim Pecuniary Loss

Nursing Home Neglect Wrongful Death Claim Pecuniary Loss

What is Pecuniary Loss – Wrongful Death Claims

Pecuniary Loss is an element of the wrongful death jury injuries (JIGs) and is not defined by statute, but through caselaw as the loss of “advice, counsel and loss of companionship.”

According to Minnesota Statutes Annotated: the statute does not define pecuniary loss. [The court has ruled in the past however], that pecuniary loss includes loss of “advice, counsel, and loss of companionship.” Jones v. Fisher, 309 N.W.2d 726, 730 (Minn.1981); see also Gravley v. Sea Gull Marine, Inc., 269 N.W.2d 896, 901 (Minn.1978) (noting that pecuniary loss includes “loss of advice, comfort, assistance, and protection”).

Minnesota jury instructions state that “[p]ecuniary loss is financial loss, but also includes loss of counsel, guidance and aid.” 4 Minn. Dist. Judges Ass’n, Minnesota Practice-Jury Instruction Guides, Civil, CIVJIG 45.45 (5th ed.2006).“Bodily injury” in the context of the Civil Damages Act has the same meaning as in the general personal injury context. See 4 Minn. Dist. Judges Ass’n, Minnesota Practice-Jury Instruction Guides, Civil, CIVJIG 45.55 (5th ed.2006). Bodily injury damages include compensation for pain, disability, disfigurement, embarrassment, and emotional distress. 4A Minn. Dist. Judges Ass’n, Minnesota Practice-Jury Instruction Guides, Civil, CIVJIG 91.10 (5th ed.2006).

Bodily injury damages are not recoverable where, as here, death occurs as a result of the injuries suffered, and plaintiffs do not seek such damages. The only damages claimed by the Bruas in this case are pecuniary loss and property damage.“Means of support” refers to financial support that, but for the accident, would have been provided to the plaintiff by the injured or deceased person. See 4 Minn. Dist. Judges Ass’n, Minnesota Practice-Jury Instruction Guides, Civil, CIVJIG 45.45 (“A person’s means of support has been damaged when the usual source of support has been [ (and)(or) will be] lost or reduced.”). The Bruas initially sought damages for loss of means of support, but ultimately dropped those claims.

Damages under the wrongful death statute are measured by “pecuniary loss resulting from the death” and include advice, counsel, and loss of companionship. See, e. g., Cummins v. Rachner,257 N.W.2d 808, 814 (Minn.1977).  See, Jones v Fisher

If a loved one has suffered from an untimely death due to the neglect of a health care professional or facility, contact Attorney Kenneth L. LaBore for a free consultation by email at KLaBore@MNnursinghomeneglect.com or by phone at 612-743-9048 or toll free at 1-888-452-6589.

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Nursing Homes Have a Legal Duty to Prevent Dehydration and Notice Dehydration Signs

Dehydration occurs when a elderly nursing home resident loses more water than they take in. The human body requires an adequate amount of fluid to function properly; for example, to regulate body temperature through perspiration, maintain blood pressure, and eliminate bodily waste. A nursing home has a duty to ensure proper hydration and to notice signs of dehydration. If severe enough, dehydration can lead to confusion, weakness, urinary tract infections, pneumonia, bedsores in bed-ridden patients, or even death. In general, a human can survive for only about four days without any fluids.

Dehydration - Nursing Home Neglect

Dehydration – Nursing Home Neglect

Dehydration Signs / Risk Factors

• Alzheimer’s, or other dementia
• Cognitive Impairment
• Major psychiatric disorders
• Deficits in mobility
• Stroke
• Repeated infections, such as MRSA, C-Diff., VRE
• Diabetes
Malnutrition or inadequate nutrition
Urinary incontinence
• Past history of dehydration
• Multiple chronic conditions
Use of medications such as: diuretics, antidepressants, psychotropics, or anti-anxiety medications, laxatives, or steroids
• Acute situations: vomiting, diarrhea and/or fevers Dehydration Signs are more prevalent in the nursing home population is more frequent for a number of reasons: • some medications, such as for high blood pressure or anti-depressants, are diuretics and cause a person to release fluids;
• other medications may cause patients to sweat more; a person’s sense of thirst becomes less acute as they age; frail seniors have a harder time getting up to get a drink when they’re thirsty; • the resident is reliant on caregivers who can’t sense that they need fluids;
Kidney function diminishes with age and are less able to conserve fluids;
• The Flu, Colds, and other Illnesses, especially one that causes vomiting and/or diarrhea, also can cause elderly dehydration.

Nursing Home Residents Also Suffer from Dehydration Due Signs to Neglect

• Failure of the nursing home to facility to provide adequate numbers staff, which results in the staff’s inability to spend the time to properly feed the residents;
• Failure of the staff members to pay adequate attention to those residents needing assistance with eating;
• Failure to properly educate the staff on nutrition and feeding methods;
• Failure to provide proper supervision over those who provide nutritional services.

Nursing Homes Have an Absolute Duty to Ensure that Residents are Properly Hydrated

Federal Law establishes that nursing homes that take Medicare residents provide each resident with sufficient fluid and water intake to maintain proper hydration and health. (42 CFR § 483.25 (j)): Hydration. The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health.

How to Identify Dehydration Signs

In addition to monitoring resident’s intake of fluid, staff should be on the conducting regular assessments of the resident looking for the following signs of dehydration:

• Dark yellow urine
• Failure to drink fluids provided with meals
• Failure to drink water provided in pictures for resident in room
• Bleeding gums
• Sunken eyes
• Ashen skin
• Dry skin
Urinary tract infection
Bedsores/Pressure Ulcers

If you or a loved one has suffered an injury from neglect or abuse from dehydration in a nursing home or other care facility that serves the elderly in Minnesota, Kenneth LaBore provides a free consultation and information regarding the obligations of the facility and your rights as a resident or concerned family member.

To contact Attorney Kenneth L. LaBore, directly please send an email to: KLaBore@mnnursinghomeneglect.com, or call Ken at 612-743-9048 or toll free at 1-888-452-6589.

Note: This website is not intended to provide legal advice as each situation is different and specific factual information must be obtained before an attorney is able to assess the legal questions relevant to your situation.

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Minnesota Nursing Home Abuse and Neglect Attorney Kenneth LaBore

Minnesota Nursing Home Neglect and Abuse Attorney Kenneth LaBore

Who is Elder Abuse Attorney Kenneth LaBore?

Kenneth LaBore is a nursing home neglect and elder abuse attorney who handles cases throughout the State of Minnesota.  Many elder abuse cases are also considered medical malpractice claims since they stem from legal duties which have some medical component which requires an expert to determine the standard of care.   If you can obtain an expert opinion that there was a breach in the professional standard of care of a care provider or facility and there are resulting damages also usually established through expert testimony or family or direct testimony.

Attorney Kenneth LaBore has handled hundreds of elder abuse and vulnerable adult neglect cases and know how to hold negligent care providers accountable.  Ken know the law, regulations, standards as well as attorneys and experts and other professionals needed to get results for his clients.  If you have an elder abuse concern and want the advice of an attorney who has experience and works hard to discover what happened and knows how to maximize the claim and litigation system for his client’s best interest – call Ken LaBore for a FREE CONSULTATION.

Elder Abuse Attorney Kenneth LaBore Handles Many Types of Elder Abuse Cases

Kenneth L. LaBore handles cases in the following nursing home elder abuse practice areas:

Contact Nursing Home Neglect and Elder Abuse Attorney Kenneth LaBore
For a Free Consultation to obtain information on how to hold negligent wrongdoers accountable from an experienced elder abuse attorney contact Minneapolis Elder Abuse Neglect Attorney Kenneth LaBore at 612-743-9048 or Toll Free at 1-888-452-6589, email: klabore@MNnursinghomeneglect.com

 

 

 

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