Stage 3 and 4 pressure injury case review
Severe pressure injuries rarely appear overnight. A wound-care or long-term care nurse traces how the injury developed: whether risk was assessed and reassessed, whether prevention matched that risk, how the wound was staged and treated as it progressed, and whether the physician and family were told. The central question is often whether the injury was avoidable.
What the nurse reviewer examines
- Admission and repeat risk scores (Braden) and whether the care plan changed when they did
- Turning and repositioning records, support surfaces and heel offloading
- Skin assessments and staging over time: first appearance, progression, measurements, photos
- Nutrition and hydration: weights, intake, dietitian consults
- Wound treatment orders, consults and response to deterioration
- Notification of the physician and family at each change of condition
- For nursing homes: the MDS assessments, care plan and federal requirements (F686)
Records to request
A starting checklist; the reviewer will flag what's missing once they have the chart.
- Complete nursing notes and flowsheets, including turning and skin assessment logs
- Wound care notes, measurements and photographs
- Braden scores and care plans with revisions
- MDS assessments (nursing homes)
- Dietary notes and weight records
- Hospital transfer and admission records showing the wound on arrival
- State survey reports and facility policies on skin integrity
Questions attorneys ask
Are all stage 4 pressure injuries negligence?
No. Some develop despite appropriate care in very sick patients. A review compares the prevention and treatment the records show with what the patient's documented risk called for, and whether the documentation itself is credible.
Who should review a pressure injury case?
A nurse with wound care or long-term care experience for the nursing issues, and often a physician for causation and the patient's underlying conditions.
Consultants
Consultants in these specialties review cases privately. Post a brief and the ones who match will see it first.
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