Risk management for pressure ulcers: when the family shows up with a camera

Pressure ulcers, although sometimes unavoidable, are frequently viewed as a failure of the health care system. Private civil lawsuits alleging malpractice or negligence related to pressure ulcers are becoming increasingly common. Because of their graphic nature, a photograph of a wound may add value to a plaintiff's case whether or not a negligent act has truly occurred. When the family shows up with a camera, caregivers should be "on notice" that a lawsuit may occur. This applies not only to nursing homes, but to any setting in which pressure ulcers occur including hospital, rehabilitation facility, home care, or hospice. When the threat of litigation arises, we recommend steps that include reestablishing trust with the family, reassessing the patient, reevaluating the care plan, documenting problem behaviors, and incorporating Quality Improvement principles.