In this case study, the plaintiff attorney's entire argument revolved around the allegation that a pressure ulcer was caused by staff not repositioning the resident in bed. (Letters to the Editor).Linda Williams, RN, Responds: In this case study, the plaintiff attorney's entire argument revolved around the allegation that a pressure ulcer Pressure ulcer Also known as a decubitus ulcer, pressure ulcers are open wounds that form whenever prolonged pressure is applied to skin covering bony outcrops of the body. Patients who are bedridden are at risk of developing pressure ulcers. was caused by staff not repositioning repositioning Laparoscopic surgery The changing of a Pt's position during a procedure to improve access or visualization of the operative field, which may be linked to complications, as it changes anatomic planes of operation. Cf Laparoscopic surgery. the resident in bed. This, of course, was not true, since the woman was seldom in bed and could reposition herself independently. The attorney also alleged that the pressure ulcer could have been healed, which was not possible because it wasn't a case of a simple pressure ulcer. It's unknown how the wound occurred, except that it was quick (from a pinch?) and left a small, superficial, clear, watery wa·ter·y adj. 1. Filled with, consisting of, or soaked with water; wet or soggy. 2. Secreting or discharging water or watery fluid, especially as a symptom of disease. mark (i.e., blister blister, puffy swelling of the outer skin (epidermis) caused by burn, friction, or irritants like poison ivy. A response of the body to protect deeper tissue, blisters generally contain serum, the liquid component of blood. ). This article didn't address the subject of MDS MDS, n See temporomandibular pain-dysfunction syndrome. MDS 1 Maternal deprivation syndrome, see there 2 Myelodysplastic syndrome, see there coding, but, as far as it goes, Ms. Corey is correct. However, the fact that any area over a pressure point must be coded as a pressure ulcer does not mean that the facility cannot obtain supporting documentation that the wound was not caused by lack of care, but by other possible causes, and present an expected outcome. Nurses should always provide full documentation of wounds and not rely solely on generic answers in an MDS. The nursing staff and attending physician in this case did not address the real problem that finally led to the resident's leg amputation amputation (ăm'pyətā`shən), removal of all or part of a limb or other body part. Although amputation has been practiced for centuries, the development of sophisticated techniques for treatment and prevention of infection has greatly . It wasn't because of a blister (that they aggressively attempted to treat); it was because of narrowed and blocked arteries in the woman's extremity extremity /ex·trem·i·ty/ (eks-trem´i-te) 1. the distal or terminal portion of elongated or pointed structures. 2. limb. ex·trem·i·ty n. 1. caused by severe arterial disease. Blisters usually heal quickly. This one didn't, and there were obvious signs of inadequate arterial circulation surrounding the foot-the skin was cold, shiny, hairless, and pale; had no pedal pulses; etc. The bottom line is that this woman was going to lose her foot or leg because of inadequate circulation, and there was nothing the physician or nurses could have done to prevent it. By not focusing on the real issue--severe arterial disease--the nurses and physician missed a real opportunity to prepare the resident and her family for what turned out to be an inevitable amputation. In short, the scope of this problem extended far beyond the coding on an MDS. Linda Williams, RN |
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