Failure to Reposition Residents Causing Pressure Sores

Failure to reposition residents causes pressure sores. In critically ill patients due to hemodynamic instability and comorbid conditions, 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 Injury Advisory Panel (NPIAP) coordinated the development of a uniform terminology, test methods and reporting standards for support surfaces. These 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 (b) Skin Integrity

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)

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. (483.25b/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, 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.

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.

NPIAP provides the following Pressure Ulcer Prevention Points

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

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

.