Connie Christian, MBA, CPHRM
Facility Risk Management and Patient Safety Advisor

Pressure-Injury Lawsuits are Common and Costly

Lawsuits stemming from pressure injury development or mismanagement are extremely common, especially those involving older adults and across care settings. One review of cases from 1987 to 2019 identified:

• A mean plaintiff age of 72.5.
• Most cases were brought due to negligence (76%) or malpractice (23%).
• Most were brought against a hospital (62%), nursing home (31%), or individual healthcare provider (7%).
• When they were found responsible, indemnities paid ranged from up to $540,000 for providers, $4 million for hospitals, and $11.7 million for nursing homes. [1]

Aging Service Organizations Continue to be at High Risk for Pressure Injuries

Along with falls, pressure injuries have consistently remained among the highest risks in aging services organizations, with both claims and indemnity payments increasing since 2018. In CNA’s 11th Edition of its Aging Services Claim Report, in 2021, pressure injuries accounted for 24% of closed claims (second-highest claim behind falls) with paid indemnity of at least $10,000, incurring an average of $252,757 per claim. While most claims are against nursing homes, claims against assisted-living facilities have increased. Since 2018, the average total incurred for pressure injury allegations in the assisted-living setting has risen by more than 67% and surpassed skilled nursing in 2021.[2]

JAMDA Study Uses Data to Predict Pressure Ulcers

The Journal of the American Medical Directors Association (JAMDA), the Society for Post-Acute and Long-Term Care Medicine’s official journal, recently published a study using patient electronic health data to predict pressure ulcers in nursing home residents with Bayesian networks. The study notes that imperfect predictive performance of tools such as the Braden and Norton scales, commonly used not only in long-term care but across all areas of the healthcare industry, prompted the use of alternative methods. A one-month prediction of pressure ulcers is possible in nursing home residents based on their EHR data. The study paves the way for the development of a predictive tool fueled by routinely collected data that does not require additional work from healthcare professionals, thereby opening a new preventive strategy for pressure ulcers, reducing patient harm, and decreasing professional liability claims.[3]

Extended Intervals for Repositioning May Keep Costs Down Without Sacrificing Care

Another 2024 study with broader implications to include acute care settings was published in the International Wound Journal using a cost analysis of the ‘turn everyone and move for ulcer prevention’ (TEAM-UP) approach to pressure ulcer prevention. The current international guideline is to reposition patients at risk for pressure ulcers every two hours. This study identified decreased staffing as a primary contributor to pressure ulcer wounds resulting from patients not being repositioned regularly. It noted that extending repositioning from three to four-hour intervals on a regular basis may be more cost-effective, and it may allow staff to stay on schedule with their repositioning efforts without sacrificing the value of preventive care.

The study also encourages those governing the international guideline that currently prescribes an interval of repositioning every two hours to consider future revisions to reflect a balance between quality and value since it takes many resources to keep residents safe from pressure ulcer harm beyond repositioning. Facilities on fixed budgets could reduce dependence on pressure ulcer repositioning frequency to every three or 4 hours and invest the time and cost savings in other technologies, such as support surfaces and monitoring devices, to better serve the needs of diverse groups of bed-bound patients without jeopardizing safety.[4]  

Regulations and Patient Safety Requirements

Facilities have current regulations that must be followed when caring for patients and residents at risk for pressure ulcers. Remaining compliant with all patient safety requirements is important. Ensuring KAMMCO members are aware of alternative methods and procedures that may, someday soon help prevent patient harm and reduce professional liability claims is the goal of this article.

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[1] Jehle CC, Hartnett D, Snapp WK, Schmidt S. Assessment of malpractice claims associated with pressure ulcers. Plast Reconstr Surg Glob Open. 2019;7(supp 8S-1):90. doi:10.1097/01.GOX.0000584732.94399.13

[2] CNA. Aging Services Claims Report: 11th Edition. March 2022. Accessed July 11, 2024. https://www.cna.com/web/wcm/connect/c6254fff-15ca-474e-929d-ca868d402917/CNA-Aging-Services-Claim-Report-11th-Edition.pdf?MOD=AJPERES

[3] Charon C, Wuillemin PH, Havreng-Théry C, Belmin J. One Month Prediction of Pressure Ulcers in Nursing Home Residents with Bayesian Networks. J Am Med Dir Assoc. 2024 Jun;25(6):104945. doi: 10.1016/j.jamda.2024.01.014. Epub 2024 Feb 29. PMID: 38431264. Accessed July 11, 2024.

[4] Padula WV, Crawford SA, Kennerly SM, Yap TL. Estimating the value of repositioning timing to streamline pressure injury prevention efforts in nursing homes: A cost-effectiveness analysis of the ‘TEAM-UP’ clinical trial. Int Wound J. 2023 Nov 1;21(3):e14452. doi: 10.1111/iwj.14452. Epub ahead of print. PMID: 37909183; PMCID: PMC10895199. Accessed July 11, 2024.