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A Man Develops Stage IV Decubitus Ulcers due to Nursing Staff's Failure to Properly Turn and Reposition Him and Follow Nursing Wound Care Protocols

Our client was a 63 year old man who presented to the emergency room with complaints of shortness a breath. Shortly after his arrival a CT scan was performed, and it was discovered that our client was suffering from an abdominal aortic aneurysm. A cardio thoracic surgeon performed an operation to repair the aneurysm. After the surgery, our client was transferred to the intensive care unit. He was assessed as being at high risk for the development of pressure ulcers because of his large size, NPO status, and because he was chemically sedated on a ventilator. Our client was unable to move independently, request assistance to move, reposition himself, or communicate pain from unrelieved pressure. He was totally reliant on nursing staff to provide basic nursing care, including: turning and providing pressure relief repositioning, visually inspecting his skin, assessing red areas for blanching at frequent intervals, assessing his nutritional status, anticipating his needs, and reporting abnormal findings to his physician. The nursing staff, however, neglected our client's needs and did not follow proper nursing protocol for his care and treatment.

Nursing staff are instructed to turn and reposition patients like our client every two hours in order to prevent pressure sores. In the ICU, our client was placed on a continuous lateral rotation bed. This is a bed that tilts patients automatically through manipulation of the mattress. The nursing staff mistakenly thought the mattress tilting would provide proper pressure relief and chose not to turn and reposition him every two hours. The hospital's policies and procedures state that even when a patient is placed on a continuous lateral rotation bed, nurses still are required to turn and reposition patients every two hours. Patient repositioning is also an important time to inspect skin condition and integrity. The nursing staff performed neither of these important duties and allowed our client to develop a pressure ulcer on his buttocks and right heel. When the pressure ulcers were first noticed by the wound care nurse, they were a preventable stage II pressure ulcer and a preventable stage I pressure ulcer, respectively. After noticing and documenting these decubitus ulcers, the nursing staff did not change their care plan or notify the doctor of the change in our client's condition.

The hospital nursing staff continued to utilize only the rotating bed for the turning and repositioning of our client. Even after decubitus ulcers had formed by using only this method, the nursing staff chose to implement no further intervention. Through the use of depositions, Todd Townsley was able to ascertain why the nursing staff chose not to manually turn and reposition our client. Two separate nurses stated that they believed that the continuous lateral rotation bed eliminated the need for manual turning and repositioning. These nurses referenced wound care textbooks to support their decision. The textbook referenced, however, stated that continuous lateral rotation therapy does not eliminate the need for manual turning and repositioning of patients. Our client did not receive adequate turning and repositioning in order to prevent the acquisition and development of pressure sores. These bed sores likely could have been prevented had the nursing staff followed proper patient care procedures and manually turned and repositioned our client. Even after his bed sores were noted, the nurses neglected our client and allowed his wound to grow larger and deeper. It was eventually staged as a stage IV decubitus ulcer on his buttocks.

Due to the wounds, our client was referred to another hospital for extensive surgical debridement. The tissue damage due to the prior two months of unrelieved pressure was so severe, the surgeon had to remove skeletal muscle to get to viable tissue. Our client was placed in an extended care facility where he received IV antibiotics and had to undergo multiple subsequent surgical debridements. Once discharged, our client had to receive home nursing care. Our client lives with daily pain in this area. The medical review panel voted unanimously that the hospital nursing staff had breached the standard of care by failing to implement proper wound prevention and treatment techniques. Todd Townsley was able favorably settle this case for our client with both the hospital and the Patient's Compensation Fund.

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