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Atlanta Legal Nurse Consultant Hosts Wound Nurse - Pressure Sores: What The CMS Guidelines Are And Are Not


Atlanta – April 17, 2009 – Atlanta legal nurse consultant, Liz Buddenhagen, RN, CLNC, had the pleasure of hosting a group of legal nurses at a speaker luncheon at Harry Bissett’s Bayou Grill, Athens, Georgia, on April 9, 2009.

Susanne Weywoda Rowan, RN, BSN, CWCCN, CLNC, spoke about “Possible Legal Implications of Upcoming Changes to CMS Guidelines.” Rowan, a specialized wound nurse, addressed specifically pressure sores.

Here’s what was talked about:

The Centers for Medicare and Medicaid (CMS) have issued new guidelines regarding preventable Hospital-Acquired Conditions (HAC), based on evidence based medicine.

For discharges occurring on or after October 1, 2008, hospitals would not receive additional payment for cases in which one of the selected HACs was not present on admission. Pressure ulcers (Category III and IV only) are one of these conditions and most are preventable per CMS.

Rowan discussed the importance of initial and accurate skin assessments upon the patient entering the healthcare facility and ongoing assessments, including ambulatory patients, with corresponding documentation. Subsequent MD verification of pressure ulcers is required and appropriate interventions by the healthcare team, involving the Wound Nurse.

Pressure ulcers are found predominantly in acute healthcare settings.

It is critical that the healthcare team avoid mislabeling non-pressure injuries as “pressure ulcer”, for instance, skin tears and friction injuries should not be labeled pressure ulcers.

Legal Implications:

Rowan indicated that the guidelines are admissible in court and can be used to educate attorneys, judges and juries, and possibly intimidate within litigation, but are not proof of liability. The guidelines are not standards of care (SOC) or proof of negligence or causation. The guidelines can be used to establish “missed opportunities.”


The Georgia Legal Nurse Consultant Society meets quarterly at different locations in Georgia to network and educate legal nurses. The meeting was facilitated by Katie Morales, RN, C, CLNC, BSN. Harry Bissetts Bayou Grill provided a superb meeting room and lunch.

About Buddenhagen & Associates:

Liz Buddenhagen, RN, Certified Legal Nurse Consultant (CLNC), is the owner of an Atlanta legal nurse consulting firm. Buddenhagen, with thirty years Professional Registered Nurse clinical background including critical care, assists Atlanta area attorneys, bringing strength and accuracy to each case.

For more information Atlanta legal nurse consulting, view website at and call Liz Buddenhagen at 770-725-2997 or email


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