Post-Operative Wound Care in Nursing Homes
What happens after surgery when a nursing home resident doesn’t get proper wound care? Post-op neglect can lead to infections, delayed healing, and costly hospital readmissions. These outcomes are often preventable with basic care and monitoring. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Khaleela Umheni to talk about the post-surgical risks residents face and how better wound care can save lives.
Umheni:
Definitely with this population you wanna be very careful. They already some of them already have compromised immune systems or circulation, and so if you drop the ball, that wound could easily become infected or it could be delayed wound healing with that wound.
Intro
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I’ll be your host for this episode. Today we’re talking about caring for nursing home residents who are fresh from A surgery, so post-op surgery. Wound care and the like, but we’re not having that conversation alone. We had the fabulous Khaleela Umheni to walk us through that process.
All right, folks. Now it’s time for the meat and potatoes. The episode, as I mentioned, we’re talking about postoperative wound care and postoperative care really in general.
In a nursing home setting, but we’re not having that conversation alone. We have Khaleela Umheni with us today. Khaleela is the founder and principal legal nurse consultant at Veritas Legal Nurse Consultants LLC, with over 15 years of nursing experience. She specializes in perioperative care, patient safety and medical record analysis.
Board certified in both operating room nursing and nurse executive leadership. Khaleela brings clinical insight and regulatory expertise to support attorneys in personal injury, medical malpractice, and toxic tort cases, and we’re so happy to have her on the show. Khaleela, welcome to the show.
What are the biggest post-operative risks for nursing home residents?
Schenk:
Walk me. Walk me through. We have someone who is gone. Gone through some type of procedure, some type of surgery. It’s so there’s gonna be some type of wound. Okay. And now they’ve gone to the nursing home for whatever reason, whether it’s long-term care or rehab or whatever it is. What are some of that individual’s biggest risks that they face at that nursing home?
Umheni:
Okay, so some risk since they just had surgery in their, in the nursing home, they would be at risk for developing blood clots. Because sometimes after surgery you may be immobile. Other things that you may be concerned about are infections related to the moon care that should be done with that surgical site.
Some other things may fall. Once again, they just had surgery. Some depending on their con previous conditions that they have before coming in they may have some dementia that may or delirium from the anesthesia that may cause some falls after surgery.
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Schenk:
What would be let’s talk about the clots, for example. So that being one of, one of the risks. What are some of the things that nursing home should take into account in order to prevent those clots?
Umheni:
If they’re mobile, I would definitely say getting them up out of bed and moving them around. That’s the number one thing to help prevent those clots.
If there’s any medications that they’re taking to prevent those clots, we wanna make sure that we’re giving those medications as scheduled. Some other things are going to be education with the family, education with the patient if they’re able to understand, so that way they can do those leg exercises in the bed to prevent those clots.
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Schenk:
What about the fall component? I think you mentioned that sometimes based on the fact that they’ve just undergone a surgery and perhaps they’re on some pain pills and things like that falls are a risk. Like how is the nursing home addressing that risk?
Umheni:
I would definitely go back to their care plan that they have in place, making sure they have the appropriate interventions in place.
So if you have it where they’re only supposed to get up with a cyst, you wanna make sure they’re only getting up with a cyst. If you have a bed that has bed alarms, you wanna make sure those bed alarms are activated. Other things. And then also educating them about making sure that, hey, you just came outta surgery.
It might have been some people, it takes up to 24. Before that general anesthesia at their system. So reminding them that, Hey, make sure you don’t get outta bed alone and we should be assisting you to get outta bed.
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How does poor wound care lead to infections in elderly patients?
Schenk:
Now let’s focus on some of the risks with respect to the wound itself from the surgery.
If there was one. First how does the nursing home know? How to care for that wound. Is this something that, A, is it a conversation between the surgeon and the nursing home? Or how do we know what we’re doing once the rest?
Umheni:
So those so every patient goes home with discharge instructions and then that discharge instructions will be instructions on exactly how often you should be changing that dressing.
Making sure that you’re doing the proper hand hygiene. And then if since if they’re in a nursing home, that physician that’s taking over, making sure they have those appropriate orders to ensure that those interventions are taking place as far as the dressing changes.
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Schenk:
How would you say, in general, if someone drops the ball with wound care, how does that, what effect, if any, would that have on the wound?
Umheni:
Definitely with this population you wanna be very careful. Some of them already have compromised immune systems. Poor circulation. So if you drop the ball, that wound can easily become infected or it could be delayed wound healing with that wound.
What are common signs that a post-op wound is not healing properly?
Schenk:
Now, what would be. Some of the signs that a wound is not being taken care of, or it’s not healing appropriately.
Umheni:
One key thing is gonna be redness warmth through the area. Pain, those are gonna be your earlier signs. In some situations you may actually have where the wound starts opening up, or you may start seeing puss coming from the site. Late signs would be. Fever, if you start developing a fever, there may be a chance that the wound isn’t getting infected.
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Schenk:
I guess other than the redness, fever, things like that, like what are some of the other kinds of symptoms of a problem or an infection and a typical surgical wound.
Umheni:
Those are gonna be your typical signs. The redness, the swelling, the pain, the puss. Those are gonna be, those are usually, like whenever I have seen people come back for, those are usually the signs they come back through the emergency room for, or the reasons why they’re calling after surgery.
Saying that, it’s very red. I’m starting to see some pus coming outta it or that it’s very painful. We know that with surgery you should expect some amount of pain from surgery, but at some point that pain should start to dissolve. And some of that tenderness should start to dissolve also.
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Schenk:
How long does it typically take for in general, how long does it typically take? An infection from a surgical wound to set in. Are we talking about weeks, days, hours?
Umheni:
So in the hospital settings when we look at wounds, an infection can develop. Within the first 30 days, you may start seeing signs of an infection.
So it may not always be immediately. Sometimes it may take up to a month. In some procedures, like total joints, it could take several months because it may be developing from where the implant was placed in there. So it can be anywhere from a few days to a month or so.
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What protocols should nursing homes follow for proper wound care?
Schenk:
So what are some of the typical or general protocols that a nursing home should be following when they receive a new admit that has a surgical wound.
Umheni:
So you definitely wanna assess it. You wanna assess that site? You wanna know what it looks like to begin with. If there are certain dressing changes that need to be done, you wanna make sure you’re doing those dressing changes according to those instructions. Also proper hand hygiene, making sure that you’re washing your hands before you’re touching that incision site is very important.
If infection was a factor in a resident’s passing, learn more about sepsis-related nursing home claims.
Schenk:
In terms of documentation. What would be important to document from shift to shift, or from week to week with respect to a surgical wound?
Umheni:
So you wanna document the way that dressing is looking, and you wanna document your dressing changes, and you want to document what the incision looks like. And they’re very important.
Episode 79: How to Prevent Sepsis in Georgia Nursing Homes outlines early intervention strategies and warning signs.
Schenk:
Okay, so that’s that, yes. So in terms of what the incision looks like, what are we documenting? Is it length and width? How many stitches is it?
Umheni:
Usually you’ll see that skin is approximated. No redness, no tenderness, no puss. But usually what I see is like the scan’s approximated with no signs of infection.
Explore care standards in Episode 143: Infection Control in Nursing Homes.
How can families ensure their loved ones receive proper post-op care?
Schenk:
I see. And if you had a family in front of you that had a loved one that just went through a surgery and is now in a nursing home. What would you tell them in terms of, some things that they can do to keep their loved ones safe?
Umheni:
I would say you definitely always wanna be involved in the care.You should know those discharge instructions, just like the nursing home knows those discharge instructions. You wanna be asking them. What does the moon look like? How often are you changing the dressing? What do the dressing changes look like? You wanna ensure that those things are happening.
Episode 98: Are Nursing Homes Liable for Infections? covers when poor hygiene or neglect leads to liability.
And then you may off wanna ask them like what are some things that you would notify me about related to this incision? If things were starting to go wrong, that ensures that the team knows. What to look for and then that, to expect when to expect a phone call if that wound starts to look bad.
Kennesaw families seeking justice after skin breakdown injuries should consult our bedsore nursing home abuse lawyers.
Schenk:
You, you mentioned discharge instructions. These are from the hospital where the surgery took place, that they’re the ones generating that
Umheni:
Yes.
Schenk:
The hospitals generating discharge. Okay. Can you break down some of the, wound related signs of infection. So not necessarily redness of the wound or the wound is coming apart, but are there any other telltale signs?
Because like for example if a family member is, if there’s a bandage and they can’t see it, they might not know that it’s red or that it’s hissed or whatever it is. What are some other indications that it’s infected?
Umheni:
So late indications would be like your family member, like.
Other signs would be there, their pain is under, not under control, or that you notice that they’re running fevers. Those are some things that you may see by talking to them or visiting if you can’t actually see the wound.
In Episode 209: Fluorescence Imaging of Wounds in Nursing Homes, we explore advanced wound assessment technology.
Why are nursing home residents at higher risk for re-hospitalization after surgery?
Schenk:
So when we’re looking at nursing home residents generally as a population, what puts them more at risk for rehospitalization after surgery?
Umheni:
So re-hospitalization. A lot of times patients in the nursing home may have a lot of chronic illnesses, and so anytime that you have anesthesia or you have surgery, some of those chronic illnesses may start to flare up. So definitely that’s a concern. Also, just being in that environment.
Depending on the kind of care that you’re receiving. Sometimes, as I said before, some of these patients may have dementia, they may have confusion where they’re not able to tell their caregivers what, how they’re feeling. So some of those signs and early signs and symptoms may be missed, and so that can lead to readmission to the hospital.
Learn which infections commonly affect elder residents in Episode 27: Common Infections Found in Nursing Home Residents.
Schenk:
Well, Khalila, we really appreciate you coming on the show and sharing your knowledge with us today. Folks, I hope that you found this episode educational. If you have an idea for a topic that you would like for me to talk about, please let me know. If you have an idea for someone that you would like for me to talk to, please let me know that as well.
And please, as always. Enter to win the coffee mug. Samuel Jackson. Favorite Samuel Jackson. But what other, their Samuel Jackson movies are there that are not Marvel, that are really good. What’s the one that was like, yes, they Deserve the da. That was a good one too. I can’t remember the name of that one.
I there Samuel L. Jackson. What else was he in? I think he was coming to America. He was the dude that robbed the McDowell’s. Was that his first? Was that his first movie, Samuel L. Jackson? Was coming to America. Samuel Jackson’s first major motion picture. I’m probably gonna be super wrong.
If anybody loves Samuel Jackson, they’re probably yelling at me right now. Let’s see. Filmography requires its own Wikipedia page, so let’s see. Oh, no. Okay, so he was, his first movie on Wikipedia is a movie called Together for Days, which was 1972. Coming to America wasn’t until 1988, but come on.
That’s the first time I saw him. He was the guy that got beat up with the broom. Eddie Murphy hit him with the broom. Anyway, new episodes of the Nursing Home Abuse podcast come out every single Monday. And with that folks. We will see you next time.
Khaleela Umheni’s Contact Information: