New Government Report on Dying in America has Implications for Wound Care

A recently released report on Dying in America has important implications for the standard of care for persons with chronic wounds who are approaching life’s end. It was published by the prestigious Institute of Medicine and written by a panel of recognized experts on the topic of end-of-life care. The Institute is the health arm of the National Academy of Sciences and acts under a …Read More

Pressure Ulcer Care in Hospitals: What We Can Learn from the Texas Ebola Debacle

A simple lapse in communication in a Texas hospital resulted in a patient with a deadly contagious disease being discharged home. The information regarding the patient’s travel history was recorded into the electronic medical record (EMR) by a nurse but not transmitted to the doctor who made the decision to discharge him. Such an error seems difficult to comprehend, but this type of communication mishap …Read More

The Old Man of the Lake on the Cover of The Gerontologist

In 2010 the closing of St. Vincents Hospital in Manhattan gifted me with time to indulge my wanderlust, and so I went to Lake Titicaca in the Bolivian highlands of South America to celebrate the winter solstice with the shamans. The Gerontologist just published a cover photo from that trip, and here is the story of the image that features an ancient ceramic portrait of …Read More

Pressure Ulcer as “Never Event”: Fact or Myth?

The term “never event” is commonly applied to pressure ulcers, giving the impression that they are always associated with medical error. As such, it lends this outcome an emotional charge that can lead to misplaced patient dissatisfaction and unnecessary accusations of wrongdoing or poor quality. Although pressure ulcers are sometimes associated with factors such as inadequate staffing and nutritional care, the preventability of all pressure …Read More

Wound Healing in the Geriatric Patient

I recently served as guest editor of a special issue on aging for Today’s Wound Clinic, a magazine devoted to contemporary approaches to wound clinic management.  This special issue on the geriatric patient was published in November/December 2013, Volume 7, Issue 9. Please take a look at the links below to the articles. The following paragraphs are reprinted from my editorial.  I developed an interest …Read More

Palliative Care for Non-Healing Pressure Ulcers

There is a saying that time heals all wounds, but this is not always the case for pressure ulcers. Those of us who care for patients with pressure ulcers know that some wounds will not heal, and cure becomes an unrealistic goal. Partnering with the patient and family to take a palliative care approach rather than an aggressive plan for healing can potentially reduce suffering, …Read More

Pressure Ulcer Guide Helps New Jersey Nursing Homes

In an unusual agreement between the New Jersey Hospital Association, the Centers for Medicare and Medicaid Services (CMS), and the New Jersey Department of Health, the Pocket Guide to Pressure Ulcers authored by myself and Elizabeth Ayello PhD, RN will be distributed to skilled nursing facilities across the state of New Jersey. Money collected through Civil Monetary Penalties for survey deficiencies will pay for purchase …Read More

Historical Roots of the “Avoidable-Unavoidable” Pressure Ulcer Controversy

Some years ago while browsing in an antiquarian bookstore I opened a volume entitled Lectures on the Diseases of the Central Nervous System by Jean Martin Charcot published in 1877. Among the yellowed pages was an illustration of a necrotic sacral pressure ulcer, and my heart started pounding. I had come across one of the earliest descriptions of pressure ulcer pathogenesis. I excitedly purchased the …Read More

New Research Sheds Light on Hospital Acquired Pressure Ulcers

A new study published in the Journal of the American Geriatrics Society sheds light on hospital acquired pressure ulcers with data on epidemiology, mortality, and patient characteristics.  Its results are certain to fuel the debate on avoidability of pressure ulcers. The researchers analyzed 51,842 discharges of hospitalized Medicare patients in 2006 and 2007 for occurrence of hospital acquired pressure ulcers (HAPU).  They found a nationwide HAPU prevalence …Read More

Pressure Ulcer Nomenclature and Documentation

Flawed and inconsistent wound documentation has serious risk-management implications.  This blog post will examine some fine points regarding pressure ulcer nomenclature and documentation. Many definitions and classification schemes for pressure ulcers were developed over the years and continue to be a source of confusion.  As patients move across the healthcare continuum from hospital to rehabilitation facility to nursing home, descriptive data can vary greatly even if …Read More

Pressure Ulcer Prevention for Patients in Wheelchairs

In most cases pressure ulcer prevention can be accomplished by risk assessment followed by common sense choices for pressure reduction.  In these days of evidence based medicine, health care providers need to listen to the evidence and implement best practices to reduce the incidence and prevalence of adverse outcomes such as pressure ulcers. An important research article on pressure ulcer prevention recently came out in …Read More

Common Questions on Coding for MDS 3.0 Section M: Skin Conditions

I recently gave another training session for nursing home professionals for MDS 3.0 Section M: Skin Conditions.  In the audience were nurses, directors of nursing, administrators, MDS coordinators and a smattering of physical therapists, doctors, and social workers.  After the didactic I fielded questions and decided to share the most common ones with my blog readers.  Question 1:  How do I code Section M0700 when …Read More

Straight Talk on Reverse Staging of Pressure Ulcers

The issue of “reverse staging” or “backstaging” of pressure ulcers as they heal is often a cause for confusion, even for some experts.  With this blog post I hope to clarify things and explain why reverse staging is now discouraged when assessing wounds, and place the issue in context with the revised Minimum Data Set (MDS) 3.0 Section M: Skin Conditions, which went into effect October …Read More

CMS Tightens Up Pressure Ulcer Classification in Long-term Care

Revised Minimum Data Set (MDS) 3.0 Section M: Skin Conditions greatly expands the process of skin assessment in nursing homes.  The accompanying Resident Assessment Instrument (RAI) Instruction Manual has instructions on how to identify and code pressure ulcers and other wounds using a methodology that is explicitly stated.  These instructions include the following: “If an ulcer arises from a combination of factors which are primarily …Read More

Updated Pressure Ulcer Guide Goes into Second Printing

The Document Dermis™ Pocket Guide to Pressure ulcers authored by myself and Elizabeth Ayello RN PhD has sold over 11,000 copies and is now going into its second printing.  Published by the New Jersey Hospital Association, the new version has been updated with consideration of Centers for Medicare and Medicaid (CMS) staging guidelines and MDS 3.0: Skin Conditions, which applies to long-term care facilities. In …Read More