Long-Term Care Survey Alert

When it comes to a bruise, pictures are not only worth a thousand words: they can head off a major abuse investigation at your facility.

Long-term care consultant Karen Clay in Brimfield, MA, tells a cautionary tale about a facility that didnt take steps to document the cause of a breast bruise in a resident receiving anticoagulation therapy for deep vein thrombosis. "The resident would normally get bruises from leaning against her merry walker when she became fatigued."

Then one day the staff noted the resident had a bruise on her outer breast in a location where it could have been caused by use of the merry walker. "Yet the bruise was also in an area that would potentially alarm the residents family," Clay reports.

Even though staff knew the bruise was likely caused from the merry walker, they went ahead and initiated an investigation. Clay says she advised obtaining a picture of the breast bruise as well as bruising that occurred the same day from a blood draw for comparison. "That way staff could show the amount of bruising that occurred from the minimal trauma known to be associated with a single, successful venipuncture."

The picture was also intended to document the breast bruise as it appeared when first noticed by the staff. According to Clay, the staff for some reason did not obtain the pictures. And the family did not see the bruise until it had grown darker and larger, which alarmed them greatly. As a result, the facility ended up being investigated by the state.