Wound Care and Liability

by lswezey on August 28, 2008

Myth # 2 - “Liability is not just limited to the MDLiability for wound treatment is limited to the doctor who writes the order”

As a healthcare professional, it is no longer enough to simply “follow orders”. All professionals who care for patients with wounds are now being held to a standard of care, and may be held liable for providing wound care of substandard quality, regardless of whether they believe they are covered by a physician’s order. Therefore, wound care practitioners need to be aware of these standards in order to protect their patients and avoid legal issues and denial of reimbursement.

Legal issues involving wound care management are generally an issue of negligence, or failure to meet the standard of care.

Malpractice can be defined as failure to meet standards of care that results in harm to another person. Healthcare professionals may be held liable in the event it is determined that standards of care have not been met, and may be guilty of malpractice if a patient under their care is harmed.

What is the standard of care in wound care management?

Standards of care can be defined as the care that any reasonably prudent health care provider would provide in the same or a similar situation. Standards for wound care practice have been determined by several sources:

  • Agency for Healthcare Research and Quality- the Agency for Healthcare Research and Quality (AHRQ) has set out guidelines for the prevention and treatment of pressure ulcers.
  • Patient Care Partnership-the patient care partnership includes basic patient rights, one of which is safe, quality care
  • State nurse practice acts and guidelines-these acts regulate the practice of nurses, and define which treatments and actions may be performed by the nurse in each state
  • Employer policies and procedures-policies and procedures are used to establish standards of care, and may be invoked in litigation claims-such claims may reflect either lack of knowledge or blatant disregard for a policy, and may show negligence
  • Job descriptions-health care employees who provide care outside their formal job description may be held liable
  • Standards of practice-various professions have individual standards of practice, set by the professional organizations

Medicare has determined that, as of October 2008, they will no longer reimburse for mainly preventable conditions, including pressure ulcers!

This ruling means that healthcare professionals must focus not only on preventing pressure ulcers, but also in treating them when they occur using evidence based wound management procedures. This is but one example of how all healthcare professionals are being held to certain standards in wound care management. It is likely that this trend will continue and that, increasingly, professionals who care for patients with wounds will be held responsible for meeting these standards.

Becoming a Certified Wound Care Professional not only guarantees knowledge of the current standards in wound care, but also ensures that the certified wound care practitioner stays current with best practice standards, as maintenance of wound certification requires proof of yearly continuing education as well as periodic retesting.

WoundEducators.com is an excellent way to prepare for certification as a wound care practitioner. As well, our program enables those who take the program to stay current with changes in the industry.

The standards are constantly undergoing change and refinement as new evidence in wound care is uncovered. Our goal at WoundEducators.com is to keep you, the reader, current with new knowledge as it becomes available.

{ 5 comments… read them below or add one }

1 Ashley 08.28.08 at 12:45 pm

I am so tired of hearing nurses say “we have to follow doctors orders” when it is clear that the doctors orders are not based on sound evidence. We need to all take responsibility for making sure our patients receive care that is based on evidence.

2 Sue 08.28.08 at 12:48 pm

It’s really scary that nurses continue to provide sub-standard wound care just because they have an MD order for it. Patients have access to the internet and are much more educated than they used to be. We better make sure that we know at least as much as they do when it comes to the wound care we are providing. I acutally had a patient ask me why I was using peroxide on her wound she said ” I thought this was bad for wounds”

3 Jennifer 08.30.08 at 8:16 pm

So True!
I too have been guilty of “following orders”–that’s no longer good enough. The advent of the Internet means that our patients are better educated and more savvy than ever when it comes to their care, and this trend is not going to end. On the one hand, we encourage patients to learn about their treatment, and are then surprised when they know what they are talking about!

4 Amy 09.03.08 at 10:23 am

12 years ago as a home health nurse I was given an official reprimand and required to write a formal letter of apology to a older doctor whose antiquated wound care orders I refused to obey…..instead, a nurse buddy and I felt we had no choice but to do it “our way” and hope that we were not found out…….later, my immediate supervisor would not even take my side over our branch manager, who defended the doctor’s right to order whatever he wanted! I had already gone the route of calling his office periodically and making other suggestions, providing documentation for my proposal and all that, with the hope that I could get some different orders. We took some comfort in the knowledge that for the 6 weeks prior to the patient’s visit to the doctor, her wound substantially decreased in size and depth. Even that seemed to make no difference to him. Morally speaking, I have no regrets. The inability of our nursing director to stand up for the patient’s right to good care, her nurses efforts to provide it, and the science of wound healing was atrocious! It feels good to finally be able to express myself over this issue.

5 lswezey 09.03.08 at 12:47 pm

Hi Amy,

Wow! That’s frustrating. Good for your for standing your ground. With the advent of evidence based wound care everyone, including doctors and institutions are being held to a higher standard. Outcomes are now being measured and shared online, and practitioners and institutions are increasingly being held accountable for the care that they provide. Hopefully these types of situations will be a thing of the past. Thanks for sharing your story.

Leave a Comment

You can use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>