Assessing Wound Management Standards for ICU Patients Transferred to Skilled Nursing Facilities

Case Overview

In this case study, we examine the situation of an adult patient who was initially hospitalized due to COVID-19. After receiving intubation, the patient spent over a month in the Intensive Care Unit (ICU). This was followed by a transfer to a skilled nursing facility.

The patient was found to have developed a large coccygeal ulcer upon arrival at the facility. Sepsis developed as a result of this wound becoming infected. The patient required extended treatment at the facility due to sepsis. There is a question of whether the standard of care regarding wound prevention and management was breached in this case.

Questions to the Wound Care expert and their responses

How often do you care for patients in the ICU and manage wound care in a hospital setting?

As an expert in wound care and emergency medicine, I have frequently provided care for patients in various settings including acute care hospitals, long-term acute care hospitals, skilled nursing facilities, and outpatient clinics.

My experience extends to supervising nurses as the medical director of both a long-term acute care hospital wound care center and a hospital-based outpatient wound care program. I also supervise nurses in my private outpatient wound care practice.

How can pressure ulcers be prevented for ICU patients?

Pressure ulcer prevention involves identifying high-risk patients using tools like the Braden scoring system. Once these individuals are identified, preventive measures include frequent turning of the patient, use of appropriate support surfaces, regular changing of dressings, ensuring adequate nutritional support, and dressing changes.

About the expert

This expert brings over three decades of experience in emergency medicine and wound care, with board certification in both areas. They have held numerous roles including a clinical instructor of emergency medicine at a renowned university, the director of wound care and hyperbaric medicine at a regional medical center. They currently serve as a wound care physician at a medical center in California. Their extensive background, coupled with active memberships in professional organizations like the Wound Healing Society, makes them highly qualified to provide insights on cases involving wound management in ICU settings.

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Specialties:

Wound Care

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.