Avoiding Malpractice: The Role of Proper Nutrition and Wound Management

Abstract

Treatment and prevention strategies for wound management have evolved in the past decade and now make it possible for physicians to successfully manage wounds in the residential setting. Wound healing is a multifaceted problem that requires comprehensive medical management and a multidisciplinary approach (Table 1). Improperly managing wounds can result, and increasingly has resulted, in a significant risk management dilemma in long-term care. “I am constantly amazed at the number of patients who were referred to me who simply need basic wound debridement that could have been performed in the residential setting,” said David K. Cobb, MD, medical director, the Wound Healing Clinic, Poudre Valley Hospital, Ft. Collins, CO. Dr. Cobb outlined the current strategies for the treatment of chronic and nonchronic wounds, as well as new insight into the physiological stress response to a wound and the effect of loss of lean body mass on the healing process. “Nutrition issues are at the core of half of the growing number of malpractice lawsuits against nursing homes,” said Deborah Warner, MS, ARNP, LHRM, CWCN, CLC, legal regulatory consultant, Warner Options, Inc., Brandon, FL. Warner emphasized that documentation is critical and noted that not all pressure ulcers are preventable and curable. Therefore, it remains critical for the medical record to accurately reflect the resident’s condition and the plan of care. “The medical record should demonstrate overall what occurred to that resident, what plans were implemented, and what the outcomes were,” she advised. Warner also stressed that good clinical practice and documentation of that practice will become even more important with pending proposed changes in nursing home survey guidelines for pressure ulcer management.