Nursing Home Neglect: The Care Plan and Bed Sores: Part III

The Chicago and South Chicago Nursing Home Lawyers at Grazian and Volpe have advocated on behalf of the elderly for over 25 years. In that time we have found that pressure sores are often preventable and the cause of serious illness and complications resulting in the wrongful death of the elder resident.

Nursing Home Neglect and Bed Sores are a related and tragic combination.  In many instances, pressure ulcers are avoidable. Previous articles on our blog have discussed applicable law and the admittance process and records for the determination of the pre-existence of pressure ulcers when an elder patient first enters the nursing care facility.  In all cases, the only true defense that may be asserted by the facility is that the resident’s condition made the development or worsening of the ulcer clinically unavoidable. Once the admitting assessment is completed and a proper care plain instituted, the issue for advocates for victims is to demonstrate either a) the care plan was deficient and/or 2) it was administered incorrectly or negligently.

Skilled Nurses and aides rely on the care plan to determine the level and type of care to be administered to an elder patient.  When dealing with victims of pressure ulcers, personal injury attorneys need to examine the care plan for interventions like special mattresses, turning and repositioning schedules, medications, nutrition, and dressings.

To ascertain whether the treatment and precautions were implemented, elder care lawyers must examine 1) Physicians orders specific for treatment and medications 2) Medical administration orders (MAR) which indicate the medications and time of administration. These are kept on a cardex located on the medical cart and initialed by the nurse and 3) Treatment administration records (TAR) which show the date and time the treatment from the physician’s orders where provided (also recorded on the cardex). All documents need be compared to make sure they are consistent and in compliance. Nursing notes known as “interdisciplinary progress notes” should also be obtained and reviewed.

The “minimum date set” (MDS) must be completed by staff and file by computer with the Centers for Medicare and Medicaid Services (CMS) to obtain payment. It indicates various assessments and observations of the resident, including pressure ulcers, cognitive abilities, mobility and diagnosis including falls and progression.  This is a snapshot of the patient filed with the government and should be compared to the other facility documents to determine discrepancies.

Finally, the “activities of daily living” (ADL) is completed by the certified aides. It is sometimes known as the certified aides flow sheet. This record addresses feeding, bathing, changing of incontinent residents, dressing and turning and repositioning. Since these are routinely destroyed, it is important the nursing care lawyers question all witnesses as to how these flow sheets were utilized and the content therein.

Together as a whole, the nursing chart and supporting records tell the story of the conditions the resident is suffering from as well as the care received. All must be analyzed to determine whether the pressure sores were avoidable.

Please do not hesitate to call the Chicago and South Chicago Nursing Home Lawyers at Grazian and Volpe if you suspect elder abuse of neglect. This call may be the key to preventing serious injury or illness.

Grazian & Volpe, Part of the Lloyd Miller Law Group