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Case Presentations
Author Information: Debbie Mitro RN, BSN CWCN, CLNC, Heidi H. Cross, RN, MSN, FNP-BC, CWON.
Purpose: When accurate clinical assessment of wounds and appropriate diagnosis of underlying conditions is lacking, optimal treatment may be delayed or absent. This often leads to deterioration and poor outcomes. Certified Wound, Ostomy & Continence nurses (WOC nurses) are knowledgeable experts in wound diagnosis and treatment. This poster will present actual skin and soft tissue injury cases with lack of WOC nurse involvement, incorrect assessments and interventions, and the resulting poor outcomes leading to litigation.
Case presentations:
Case #1: Mr. AB, 55 years old, was admitted with necrotizing fasciitis of the genitals. Incorrect assessment and treatments delayed the surgical intervention, leading to an unfavorable outcome. The case was settled prior to trial.
Case #2: Mrs. RP, 75 years old, developed an unstageable pressure injury on her right heel. With severe peripheral vascular disease (PVD), this deteriorated to massive gangrene of the lower extremity. No WOC nurse was involved and no appropriate diagnosis was made, leading to amputation.
Discussion: This poster highlights primary factors involved in skin and soft tissue injury lawsuits. These include involvement of a WOC nurse, adequate medical history, meticulous skin and wound assessments, proper pain assessment and treatment, analysis of past and present symptoms, vital signs, appropriate lab values, diagnostic tests, and collaboration with a physician. Overlooking any of these factors largely determined the initiation and the outcome of litigation.
Conclusion: WOC nurses play an intricate role in the early detection and assessment of skin and soft tissue injury and the possible detrimental outcome from delayed diagnosis and treatment. Collaboration with facilities and healthcare providers is essential for best practice and avoiding lawsuits.