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
New Rules for Pressure Ulcer Risk Assessment in Nursing Homes
MDS version 3.0, the mandatory assessment tool for residents of skilled nursing facilities, was finally implemented October 2010 after years of planning. Section M: Skin Condition has been completely revised and expanded. This blog post will address MDS 3.0 sub-section M0100: Determination of Pressure Ulcer Risk, which approaches “at-risk” status in a much more sophisticated and clinically acceptable manner than past versions, enabling better targeting of preventive …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
Geriatrics Review Syllabus Audio Companion: Review Of Pressure Ulcers
January 8, 2011 The Geriatrics Review Syllabus (GRS7) Audio Companion is designed to keep professionals up to date on geriatric medicine, and also for doctors who are preparing for Board Examinations. Dr. Jeffrey Levine recorded the audio version of a review of pressure ulcers for the American Geriatrics Society’s current versiion of the Geriatrics Review Syllabus. The content goes into the basics of risk factor …Read More
