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
Government Study Cites Flawed Medical Device Approval Process
FACT: Many wound-care products are considered “medical devices” with limited data on efficacy. A new study released by the Institute of Medicine points out that the FDA’s approval process for medical devices is flawed. Medical devices include high profile items such as hip replacements, but this class of products also contains many items on the market to treat chronic wounds. The New York Times noted that even …Read More
Healthcare Reform Provision Helps Lawsuits Against Nursing Homes
A little known provision of President Obama’s Healthcare Reform Act is designed to help plaintiffs and their attorneys bring legal action against nursing homes for alleged neglect and abuse. With the demographic transformation of America toward an aging society, lawsuits against nursing homes have surged. In response some privately owned nursing homes have developed complex corporate structures that obscure who controls the facilities, making it difficult for attorneys …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
How Much do Medical Residents Know about Pressure Ulcers?
The Answer: Not as much as nurses!! This past weekend I presented a new study on how much medical residents know about pressure ulcers at the American Geriatrics Society (AGS) Annual Scientific Meeting in Orlando, FL. In our research we tested medical doctors in residency training at a major New York City hospital. For those of us who do wound care on a day-to-day basis, our results …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
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 Association, the guide has been over two years in development. It is intended to help clinicians stage pressure ulcers and correctly …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
