Pressure Ulcer Staging: Should I Get My Raincoat?
For more than 20 years the National Pressure Ulcer Advisory Panel (NPUAP) has provided leadership in major topics surrounding pressure ulcers, including standardization of the staging system and introducing useful additional classifications of Unstageable and Deep Tissue Injury. However, recent changes on their website show new nomenclature that, in my opinion, risks introducing confusion for caregivers and policy makers. It looks like NPUAP is adding …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
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
Does MDS 3.0 Section M Avoid the Unavoidable?
The revised Resident Assessment Instrument (RAI) with the new MDS 3.0 Section M: Skin Conditions radically expands the assessment process for pressure ulcers in Medicare certified skilled nursing facilities. In contrast to the prior version, there are data fields for improving or deteriorating pressure ulcers, ulcer measurements, and tissue type at the base of the wound. Important issues such as “present on admission” and updated …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
Determining the Avoidability of Pressure Ulcers
One of the biggest challenges in caring for patients with pressure ulcers from a risk-management standpoint is determining whether the ulcer was avoidable. The National Pressure Ulcer Advisory Panel has recently come out with a statement that “Not all pressure ulcers are avoidable.” As a reference point, we can look at the Interpretive Guidelines for F-Tag 314 issued by the Department of Health & Human …Read More
Teaching America How to Assess Wounds
Last week I presented at the Center for Medicare and Medicaid Service’s (CMS) Train-the-Trainer program in Las Vegas for the introduction of Minimum Data Set (MDS) 3.0 which will go into effect October 1, 2010. This assessment tool will impact 17,000 nursing homes and 1.6 million people who reside in them across America. My assignment was to introduce Section M: Skin Condition, which represents the assessment for pressure …Read More
Pressure Ulcer Prevention Lacking in High Risk Patients
A major study published in The Gerontologist has shown that pressure ulcer prevention measures are lacking in high risk patients. A research group based in the Department of Epidemiology and Preventive Medicine at the University of Maryland School of Medicine studied elderly patients with hip fractures, following them across care settings that included hospitals, rehabilitation facilities, and nursing homes and found inadequate use of pressure-redistributing …Read More
Wound Healing Products: From Ancient to Modern Mythology
Greek mythology tells us that filings from the rusty spear of Achilles were used successfully on a non-healing wound. To this legacy of using metal derivatives to heal wounds, a newer, more modern mythology has been added. This is the use of silver in wound-care dressings. Telephus was a hero of Ancient Greece who fought in the Trojan War. When fleeing a battle his leg was …Read More
Caution Urged with Negative Pressure Wound Therapy
I recently was called to consult on a man whose sternal wound was being treated with negative pressure wound therapy (NPWT). He had undergone a coronary artery bypass operation and his chest wound had opened up. His doctor prescribed NPWT but after the third day the canister was filling with blood and clots. The wound had started bleeding, and the NPWT device was sucking blood …Read More
Wound Care: What About Larval Therapy?
Myiasis is the medical term for infestation with the larvae of a fly, also known as maggots. The image of maggots in modern society is the exact opposite of health and cleanliness. Indeed, unintended myiasis in a healthcare facility is a frequent precursor of a negligence or malpractice lawsuit. Despite their repugnant image, there are companies that sell fly larvae for use in the care of …Read More
New Pocket Guide to Pressure Ulcers
A new wound guide written specifically for clinicians has just been released. The complete title is “Pocket Guide to Pressure Ulcers: How to Classify, Stage, and Document Pressure Ulcers and Other Common Wounds.” Written by me and Elizabeth Ayello RN, PhD, and published by the New Jersey Hospital Associa- tion, the guide has been over two years in development. It is intended to help clinicians stage pressure ulcers and …Read More
Peripheral Arterial Disease is Underdiagnosed in the Elderly
When ulcers of the lower extremity develop, it is important to find out why. Many ulcers develop over boney prominences which are subjected to pressure, and are therefore labeled as pressure ulcers. However, one common etiology of lower extremity wounds is frequently not considered, particularly in elderly persons. This is atherosclerotic disease of the lower limbs, also called peripheral arterial disease, or PAD. The term …Read More
Wound Odor: The View from Ancient Greece
The fascinating history of wound care dates back to the earliest human cultures, where prehistoric bones and cave paintings left hints of wound-healing knowledge. A major problem associated with wounds is odor, a phenomenon recognized for millennia. In today’s practice, when examining and documenting wounds, the standard of care requires noting the presence of odor. Odor associated with a wound can result from necrotic tissue …Read More
Skin Surveillance Under Medical Devices is a MUST
Most educational materials on pressure ulcer prevention tell you that the most common areas for pressure ulcers are under boney prominences such as the sacrum, ischium, and heels. However, an area that is frequently under-emphasized in pressure ulcer prevention education is skin breakdown under medical devices. Tissue damage under medical devices is therefore frequently overlooked when performing skin assessments, and this can result in devastating consequences of …Read More
Pressure Ulcer Regulations in the Nursing Home: Introduction to Revised F-Tag 314
Care delivered in nursing homes is highly regulated, particularly for pressure ulcers. Whatever your opinion of government regulation, laws governing nursing homes undoubtedly provide added protection for these vulnerable adults across America. This post will provide a basic explanation of regulations covering pressure ulcers in the nursing home which have been recently revised and expanded. But first I will provide some definitions of terms. Nursing …Read More
How CMS Views Pressure Ulcers in Hospitals
Since October 1, 2008 the Centers for Medicare and Medicaid Services (CMS) classified pressure ulcers as a preventable Hospital-Acquired Condition (HAC) that will no longer be reimbursed by current insurance guidelines. In order to understand how this works, I first need to provide some definitions: MS-DRG: Diagnosis Related Groups (DRG) is a system for classifying hospital cases into levels reflecting hospital resource utilization. MS-DRG stands …Read More
