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Without assessment and prevention, it doesn't take long for a hospitalized patient to get a pressure wound

HCA Houston Healthcare West Hospital hit with Medicare citation for inadequate registered nursing supervision of wound care

Patients go to the hospital for medical help, not to get a new injury. Hospital or healthcare-acquired injuries are so common, though, that there’s a special term to describe them—iatrogenic injuries.

One of the most common types of iatrogenic injury is pressure injuries. This dreaded condition goes by other names, including decubitus ulcers, pressure sores, and bedsores. These injuries are often avoidable and cause a significant amount of pain and treatment, and even death. Plus, the price tag is significant. One study estimated that the cost of treating hospital-acquired pressure injuries could be over $26.8 billion.

Pressure injuries are so common and preventable that a standard of care developed requiring a pressure injury assessment and prevention plan for every hospitalized patient. This is a multidisciplinary responsibility shared by the nursing staff, physicians, and other medical providers. In reality, though, it’s registered nurses who bear the most responsibility for screening for skin integrity and risk and implementing interventions to avoid pressure injuries.

Last year, the Centers for Medicare and Medicaid Services cited HCA Houston Healthcare West Hospital, located at 12141 Richmond Ave., in Houston, Texas, for substandard registered nursing (RN) supervision of nursing care based on pressure injury concerns.

According to the violation, which was issued on February 12, 2021, a Medicare surveyor reviewed medical records from hospital admissions through the emergency department. The surveyor reviewed seven charts and found three of them lacking in terms of the nursing staff assessing and elevating patients for potential skin breakdown.

One elderly patient was admitted to HCA Houston Healthcare West for respiratory distress. Upon admission, the patient had no pressure wounds or skin integrity concerns. Within days, though, a wound care assessment was ordered after both of her hips and sacrum had open pressure injuries with scar tissue, and both of her feet had deep tissue injuries.

Another patient was hospitalized for acute hypoxic (inadequate oxygen) respiratory failure caused by pneumonia. Upon his admission, he, too had no skin issues. Within two days, though, his sacrum had an advanced (Stage III) pressure injury.

A final patient was admitted to the hospital for an anoxic (absence of oxygen) injury because of aspiration pneumonia. On admission, his skin was fine, but four days later it wound care consult was ordered because of new skin integrity issues.

The Medicare surveyor noted that the nurses caring for these patients didn’t comply with the hospital’s own policy called “Clinical Practice Guidelines for Skin Alterations.” The purpose of the hospital’s policy was, “To ensure all patients will be properly screened for the presence of skin alterations (also known as wounds, ulcers, injuries) and for risk of, or presence of pressure injuries.”

The hospital policy sounds appropriate on paper. As a former hospital administrator, though, I know that having good policies on file isn’t enough. Hospitals must hire and staff units with an adequate number of nurses and conduct continued training on how to assess and prevent pressure injuries. The whole package is needed for real patient safety in wound prevention and care.

If you’ve been seriously injured because of poor hospital, nursing, or medical wound prevention or care in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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