Remote monitoring devices allow for wireless patient monitoring.  The monitors typically track temperature, pulse, blood pressure, glucose, and personal data (weight, pain, drugs).  The system can record and transmit data to doctors.  In the case of patients who do not live near medical support, it can transmit vital information to doctors to alert them of any change in patient status.  For nursing home residents, remote monitoring can help staff better monitor residents and focus their attention on the patients who need medical assistance.  The system is particularly helpful for monitoring patients with chronic diseases including diabetes, heart failure, and patients recovering from strokes.  In addition, remote monitoring prevents unnecessary trips to the doctor and hospital, which can reduce costs.

As new technologies are incorporated into patient care, there must also be standards set on how to monitor data and how often.  Even though doctors and nurses do not need to physically take a patient’s vital signs, they still need to review the data.  However, overall, this will free up a lot of time for doctors and nurses because of reduced need for office visits.

The FCC (Federal Trade Commission) delivered its National Broadband Plan to Congress in March.  The FCC promotes broadband to save money in healthcare with the use of remote monitoring of health records and patients’ vital signs.  Together, remote monitoring and electronic health records could save as much as $700 billion over 15-25 years.  (See “Is It Time For Nursing Homes To Embrace Electronic Medical Records?”)

Remote monitoring offers one option to improve patient care and safety, while also reducing costs.  But, it is unclear how likely the use of remote monitoring will be in nursing homes in the near future.  Until then, it is critically important that nursing homes are properly staffed, so that residents receive the proper care and supervision to achieve or maintain the best possible health and prevent medical conditions such as pressure ulcers.

Sources:

Broadband.gov: Broadband & Health Care

Med Health World: Patient Monitoring Without the Wires-Is Ultra Wideband Frequency the Future?

Bed Sore FAQ

Nursing Homes Abuse Blog: Is It Time For Nursing Homes To Embrace Electronic Medical Records?

Medical News Today: Remote healthcare monitoring not so distant

New York Times: Remote Control for Health Care

Nursing Homes Abuse Blog: Are assisted living facilities responsible for the prevention of bed sores in their patients

The sun article concentrates on 60-year-old Tyrone Bush, a maintenance man, who was admitted to Desert Springs Hospital for a quadruple heart bypass surgery in 2008. It was during Bush’s recovery at the hospital, that he developed multiple bed sores (or pressure sores, pressure ulcers, decubitus ulcers) on his buttocks.

Pressure sores (also known as decubitus ulcers, bedsores, and pressure ulcers) are areas of skin and tissue that have been damaged by inadequate blood flow because of sustained pressure.  Nursing home residents and hospital patients are at increased risk for pressure ulcers because of decreased mobility, wheelchairs, and bed confinement.

Common areas to suffer from decubitus ulcers are the:

• Buttocks
• Heels
• Lower back
• Shoulders
• Hips
• Knees
• Ankles

Pressure mapping is a useful tool for doctors to help assess patients who are susceptible to developing pressure sores and  making an early diagnosis in patients with existing pressure sores.  A pressure map helps reveal what is happening underneath a patient’s skin.  It allows doctors to see areas of pressure under a patient’s skin that are not yet apparent on the skin’s surface.

The mapping device is actually a thin mat that has sensors attached to it.  The mat is placed between the patient and the bed, wheelchair, or other seating surfaces.  These sensors, which are attached to a computer, read the amount of pressure exerted on them, creating a color-coded map of the pressure distribution.  This image can help a caregiver determine high-pressure areas.

Then, the caregiver can implement preventative measures so pressure sores do not occur.  Pressure-reducing measures include changing positions more often, changing body position, changes in equipment, using special cushions, pads, mattresses, and beds that relieve pressure, and using foam, air, or water-filled devices to cushion a wheelchair seat and foot rests.

Pressure mapping systems are not without their problems.  There are some concerns with the lack of standardization in how different devices report pressure readings.  In addition, some devices simply report an average pressure reading over a larger area, which might under-report the pressure in small bony areas surrounded by lower pressure areas.  Therefore, pressure maps should be used as just one tool in effectively diagnosing and preventing pressure sores.  It is important that doctors and caregivers still perform detailed skin inspections for signs of pressure sores.

Pressure mapping systems can help prevent dangerous and painful pressure sores, which improves quality of life and reduces the cost of treating pressure ulcers.  However, some facilities might not be able to afford the high cost of such a system.  Ridge Meadows Home Care Team was able to purchase a $17,000 Pressure Mapping System because of a $10,000 donation.  When choosing a nursing home facility, it is important to ask about preventative measures such as a pressure mapping system, especially if you are at increased risk for pressure sores.

Sources:

Maple Ridge News: Pressure Mapping System to Treat, Prevent Bed Sores

Lippincott’s Nursing Center: Wound and Skin Care – Can pressure mapping prevent ulcers?

Northwest Regional Spinal Cord Injury System: Picture This . . . Pressure Mapping Assessment for Wheelchair Users

Optimal Positioning: Wheelchair Seating Comfort and Pressure Mapping

Well according to a California jury, the answer is ‘yes’.  $28 million is the amount of punitive damages the jury awarded in the elder abuse and wrongful death case (Sacramento Superior Court) against Colonial Healthcare of Auburn and its parent company Horizon West of Rocklin.  This case revolved around the abuse and death of Ms. Frances Tanner, a 79-year-old resident, who died from an infected bedsore.  Punitive damages were awarded because the jury determined that the nursing home was “malicious, oppressive, or fraudulent.”  In addition, the jury awarded Ms. Turner’s daughter, Elizabeth Pao, $1.1 million for loss of companionship and her mother’s pain and suffering.

Ms. Frances Tanner was admitted to Colonial Healthcare of Auburn in March 2005 with a diagnosis of dementia.  Then, in September 2005, Ms. Tanner fell and broke her hip.  The nursing home did not conduct a timely assessment of her injury, which resulted in a delay in treatment.  It took eight days after Ms. Tanner’s fall for the nursing home to diagnose her with a hip fracture.  It was at this point that staff members also discovered a bedsore (also known as a pressure sore, decubitus ulcer, or pressure ulcer).  A few weeks after undergoing hip surgery, Ms. Tanner died from an infected bedsore.  (See “Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?”)

Bedsores are a very serious and dangerous problem for nursing home residents, especially those who have limited mobility.  When Ms. Tanner suffered a fall, the nursing home should have first conducted a thorough examination, with special attention given to a possible hip fracture.  Hip fractures are a very common injury in elderly nursing home residents because of weak bones.  Second, nursing home staff should have implemented measures to prevent bedsores during her recovery because of Ms. Tanner’s reduced mobility.

It is unthinkable that it took the nursing home eight days to discover the hip fracture and bedsore.  Then, what is even worse is that the nursing home facility allowed Ms. Tanner’s bedsore to progress to such a level that the resulting infection actually killed her.  (See “Are the development of bed sores during a nursing home admission an indication of nursing home neglect?”)  Decubitus ulcers are incredibly painful, and it is likely that Ms. Tanner spent her final days in pain from her hip fracture and infected bedsore.

Bedsores are a preventable injury.  When a nursing home resident suffers an injury that leads to reduced mobility, the nursing home should implement special preventative measures to ensure that no bedsores occur.  In fact, nursing homes must do this.  They must take steps to prevent bedsores.  Then, if a resident does suffer from a bedsore, the facility must provide proper care and treatment to ensure that the bedsore heals and does not worsen.  Healthcare of Auburn directly contributed to the death of Ms. Tanner.  The elder abuse and wrongful death charges are important to hold the facility responsible, and the punitive damages help to further punish the nursing home and prevent future tragedies.  However, they do nothing to bring Ms. Elizabeth Pao’s mother back.

Resources:

The Sacramento Bee: Jury Hits Auburn Nursing Home with $28 Million in Punitive Damages

The Washington Examiner: Jury Awards $29.1 million in nursing home death

Bed Sore FAQs: Are the development of bed sores during a nursing home admission an indication of nursing home neglect?

Bed Sore FAQs: Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?

• Screening all new admission for decubitus ulcers
• Encouraging patients who are physically able to use the toilet as opposed to diapers
• Empowering all hospital staff: physicians, CNA’s, RN’s and others to identify and document all signs of early stage decubitus ulcers when caring for patients
• Implementing extra skin checks for physically disabled patients or those who constantly use medical equipment like oxygen masks or tubing
• Analyzing all patient records on a quarterly basis to determine which preventative techniques are working and those that are not

Caseyville Nursing and Rehabilitation Center is a 150-bed facility located in Caseyville, Illinois has a one-star rating from Medicare Nursing Home Compare, which is a much below average rating.  Not unsurprising considering the poor treatment Mr. McManus received, Caseyville had twelve health deficiencies between January 2009 and March 2010, which is four more than the Illinois average and the U.S. average.

Mr. McManus seems to be the victim of neglect.  In the final month of his life, he suffered from a series of health problems including:

• Bed sores
• Urinary tract infection (See “Untreated Urinary Tract Infections in Nursing Home Patients May Result in Urosepsis”)
• Malnutrition (See “Can malnutrition cause bed sores?” and “Inadequate Nutrition & The Development of Bed Sores in Nursing Home Patients”)
• Dehydration (See “Can dehydration contribute to the development of pressure sores?”)

Bedsores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) are a very serious and preventable problem that affects many nursing home residents.  Nursing homes are required to ensure that residents do not develop pressure sores and provide treatment and services to promote healing and prevent infection for residents with existing pressure sores.  Oftentimes, these victims do not receive adequate care and services that would prevent these painful and dangerous injuries.  If not properly treated, decubitus ulcers can progress rapidly, damaging tissue and bones and cause sepsis or even death.  It is saddening that this is how Mr. McManus spent the final days of his life, in pain and agony.  Coupled with the horrible physical pain was the victim’s deteriorating mental state and distress.

Ms. Shirley McManus is now suing the nursing home facility for wrongful death, alleging that the facility committed several negligent acts that resulted in his death.  Her lawsuit alleges that the nursing home failed to provide adequate care, failed to protect Mr. McManus from abuse and neglect, failed to notify his doctor of a change in physical condition, failed to create a care plan that addressed his pressure sores, and also failed to maintain his body weight.

Situations like this should not occur in nursing homes.  Residents are entitled to receive necessary care and services in order to attain or maintain the best possible physical, mental, and psychosocial well-being.  If you or a loved one are not receiving this minimum level of care and have suffered injury, you may be entitled to compensation

Sources:

Madison St. Clair Record: Woman Sues Caseyville Nursing Home Over Man’s Death

Illinois Department of Public Health: Caseville Nursing & Rehab Ctr

Medicare Nursing Home Compare: Caseyville Nursing & Rehab Ctr

Untreated Urinary Tract Infections in Nursing Home Patients May Result in Urosepsis

Can malnutrition cause bed sores?

Inadequate Nutrition & The Development of Bed Sores in Nursing Home Patients

Can dehydration contribute to the development of pressure sores?

Sepsis is a deadly, yet surprisingly common medical condition.  According to a recent sampling of hospital patients:

• Sepsis is the 10th leading cause of death in the U.S.
• 33% of people who contract sepsis will die from the disease
• Medical expenses to treat sepsis cost approximately $17 billion per year

The Banner Desert Medical Center in California recognized the substantial problems associated with sepsis and has begun to implement a prevention and treatment program.  Believed to be the first of its kind, the California hospital uses a scientific formula to detect warning signs that indicate a patient is at risk for contracting sepsis.  The diagnostic program evaluates:

• changes in body temperature
• increases in heart rate
• changes in respiratory rate
• decreases in white blood cell count

After the early symptoms of sepsis are identified, the hospital is able to rapidly administer medical treatment and greatly improve the patients survival rate.  In the first two months of its use at Banner Medical Center, the hospital credits the new program with the early detection of sepsis in 60 patients  and likely a substantial number of lives as well.  Read more about this important development in sepsis prevention here.

Hopefully this sepsis detection tool can be applied to patients in a nursing home setting as well.  Too often the implementation of medical treatment for nursing home patients is delayed due to inadequate training of staff and insufficient medical equipment.

Related Bed Sore FAQ’s:

Is sepsis related to bed sores?

Are bed sore patients at risk for amyloidosis?

Why is a colostomy needed for patients with severe bed sores?

Why are physically disabled patients at risk for developing bed sores?

In the case believed to be the first of its kind decided by a Philadelphia jury, the punitive damages were allocated: $1.5 million against the hospital and $3.5 million against the nursing home.

According to the lawyer for the man’s family, Steven R. Maher, Jeans Hospital failed to diagnose the man’s urinary tract infection that contributed to the development of bed sores (also referred to as: pressure sores, pressure ulcers or decubitus ulcers) and then the man was transferred to Hillcrest Nursing Home where the bed sores worsened.  After a courageous battle attempting to heal the decubitus ulcers at home for more than two years, the man succumbed to complications related to the decubitus ulcers.

Jeanes Hospital is part of the Temple University Health System and Hillcrest is owned by Genesis HealthCare Corporation, a large nursing home operator in the Northeast.

Unlike compensatory damages that are intended to compensate an injured party for their loss, punitive damages are only awarded in situations where a court determines the conduct to be outrageously negligent or reckless. In cases involving decubitus ulcers, punitive damages may be appropriate when staff repeatedly fail to tend to their duties over extended periods.  No doubt that the plaintiff’s lawyers were persuasive, but my guess is that the testimony and photographs (if any) really incited feelings of rage.

Additionally, this case is important because too often we see different medical facilities point their fingers at the other facility.  Here we see that even when a patient arrives at a nursing home in a less that ideal condition, facilities still have an obligation to provide the patient with quality care to prevent further deterioration.

Related Bed Sore FAQ’s:

What can hospitals do to reduce the rate of bed sores in their facilities?

If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?

After I become aware of a bed sore, should I photograph it?

Are the development of bed sores during a nursing home admission an indication of nursing home neglect?

In this sense, the son of a deceased nursing home patient blames ‘under-staffing’ as the reason why his mother fell and subsequently developed pressure ulcers at the facility.  As the special administrator of his mother’s estate, Gary Brown filed a nursing home negligence lawsuit against a county operated nursing home in Nebraska alleging that his mother’s injuries and death could have been prevented had the facility had adequate staff.

As is frequently the case in with injuries occurring in the nursing home setting– one error leads to the development of another.  In the case of this lawsuit, it is alleged that after the facility failure to supervise the woman resulted in a fall and hip fracture.  After the hip was surgically repaired, the facility failed to acknowledge the fact that the woman’s immobility that accompanied put her at risk for developing pressure ulcers (also referred to as pressure sores, decubitus ulcers or bed sores) during her recovery at the facility.

The facilities negligence continued even after the pressure ulcers developed as the pressure ulcers advanced and became infected.  Further complicating the situation is the fact that the the facility failed to notify the woman’s son or personal physician of her pressure ulcers.  Finally, Mr. Brown claims that the pressure sores contributed to his mother’s death.

Read more about this nursing home negligence lawsuit involving the development of pressure ulcers here.

Nursing Homes Obligation To Prevent  & Treat Pressure Ulcers

Every patient coming into a nursing home must be assessed to determine their risk for developing pressure ulcer and a care plan must be developed to meet the patients needs.  When facilities are inadequately staffed or staff never receives proper training, many of the preventative measures set forth in a care plan never get done and patient injury frequently ensues.

Pressure ulcers are a known problem facing patients in nursing homes and hospitals with limited mobility. Pressure ulcers may develop when patients are left in one position for extended periods of time.  Patients who remain in one position for extended periods are at risk for developing pressure ulcers as limited blood flow to the area results in the gradual decay of tissue.

Consequently, many nursing home patients need to be ‘turned’ on a regular basis.  Many facilities have charts to help staff keep track of the re-positioning schedule for each resident.

In order to reduce the incidence of pressure ulcers, nursing home residents should be:

• Kept clean and dry, particularly those patients who may be incontinent
• Moisturized daily
• Washed regularly with mild soap and water
• Changed positions on a regular basis to chances of unrelieved pressure
• Kept well fed and hydrated
• Kept the bed elevation as low as possible- this reduces pressure on the sacrum and buttocks– areas where pressure ulcers frequently develop

Related Bed Sore FAQ’s:

What are the signs of infection for people who have bed sores?

What should I do if my family member develops bed sores during an admission to a nursing home?

What areas of the body are prone to develop bed sores?

What type of legal recourse does a person with bed sores have?

Similarly when people hear of the ongoing medical procedures that are necessary to heal the wound, and the pain experienced by the individual, they really begin to understand the real impact of this medical condition. The reality is that bed sores kill patients in nursing homes and hospital– needlessly.

The visual impact and physical devastation to the man that was caused by the bed sores is likely what caused a New York jury to make their substantial award in a lawsuit filed by the family of a deceased man who developed bed sores in a nursing home.

The man’s daughter’s Margaret Whitehurst, said her father’s medical condition quickly declined during his nine month admission to Brooklyn, NY facility.  “He walked in on two legs and a cane.  He was 237 pounds.  When we got him back, he was 148 pounds and had holes all over his body.”

During the trial, the jury heard testimony from the man’s family and physicians regarding the severity of his bed sores (also called: decubitus ulcers, pressure ulcers or pressure sores), and also from a handwriting expert who testified about how the man’s nursing chart was altered.  According to the handwriting expert’s testimony, the admission paperwork was altered to look as though the man entered the facility with bed sores, although his family and physicians strictly denied that fact.

Certainly, hearing that the nursing home records were altered in this matter must have swayed the jury to make such a large award for punitive damages.  Punitive damages are usually awarded after a judge has given the plaintiff leave to file a prayer for such.  Unlike compensatory damages intended to compensate an injured party, punitive damages are intended to punish the wrongdoer.

Related Bed Sore FAQ’s:

Are the development of bed sores at a nursing home considered to be a form of nursing home abuse?

What are the causes of bed sores?

If a lawsuit or claim is filed against a facility where a person developed bed sores, what type of damages is the person entitled to?