Topics Covered:

• Pressure Ulcer/Injury Prevention
• Staging of Pressure Ulcer/Injuries
• Framing your wound management program using the Wound Bed Preparation model of care
• The Kennedy Terminal Ulcer/Skin Failure, Unavoidable Pressure Ulcer
• The Wound Assessment
• Documents review that support CMS regulations for wound prevention and care in the Long-Term, Sub-Acute Care Setting
• Focus on F684, F686, and F687

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Objectives: At the end of this program participants will be able to:

• Recognize the components of the pressure ulcer/injury prevention program
• Stage pressure ulcer/injuries according to the State Operations Manual
• Define the Kennedy Terminal Ulcer, Unavoidable Pressure Ulcer/Injury
• Design the wound management plan of care using the Wound Bed Preparation model
• List components of F687 for care of the feet of people with diabetes
• Participate in a wound type/tissues recognition skills lab

Course Faculty:
Dr. Pamela Scarborough, Director of Public Relations and Education for American Medical Technologies. 

​Continuing Education Credits:

• AMT Education Division is a provider of Continuing Nursing Education by the California Board of Nursing.  Provider Number CEP 15291.
• This course is approved for 6.0 hours of continuing education for nurses.

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Meet the AMT team at the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) annual convention & expo scheduled to be held in San Diego, CA from October 7-10, 2018. We will be exhibiting in the expo hall - please stop by booth #1837 to get complimentary educational materials, learn about our senior care solutions and win an Apple ipod!

• ​Title: Adapting the pressure ulcer/injury staging language into your clinical practice and reporting mandates in long-term care
• Date: Thursday, September 20, 2018
• Time: 2:00 – 3:15 pm Eastern
• Download flyer: Click here
• Register: Click here

This program will assist clinicians in differentiating between the CMS State Operation Manual’s and the National Pressure Ulcer Advisory Panel’s pressure ulcer/injury definitions and staging descriptions. Content will guide the attendee in how to adapt this information into clinical and reporting practices for long-term care. This information is valuable to both new and seasoned wound care clinicians in the long-term care setting. 

At the end of this presentation participants will be able to:

• Recognize and compare the State Operations Manual’s Guidance to Surveyors and the National Pressure Ulcer Advisory Panel’s pressure ulcer/injury definitions and staging descriptions.
• Identify current CMS pressure ulcer/injury description and definitions for reporting and clinical best practices for documentation in the medical record.

Space is limited to the first 500 participants nationally. To reserve a spot, all are encouraged to register early.

Meet the AMT team at the Oregon Healthcare Association (OHCA) annual convention & tradeshow scheduled for September 17 and 18, 2018. Our team will be exhibiting at the trade show - please stop by booth #400 to get complimentary educational materials and learn about our senior care solutions.

The Social Security Act mandated “the establishment of minimum health and safety standards that must be met by providers and suppliers participating in the Medicare and Medicaid programs”. The Centers for Medicare and Medicaid Services (CMS) has been tasked by the Secretary of the Department of Health and Human Services (DHHS) to administer these programs and ensure compliance. CMS therefore provides regulatory guidance to providers and suppliers through a document known as the State Operations Manual (SOM). Appendix PP of the SOM contains, among other items, minimum standards for wound care documentation in the long-term care setting. (4)

These standards are specifically found in Section 483.25 of Appendix PP of the SOM which gives rise to multiple F-tags, including the F-tag 686 (F686: Treatment/Services to Prevent/Heal Pressure Ulcers) and the F-tag 684 (F684: Quality of Life). F686 specifically addresses the minimum assessment, daily monitoring, and weekly documentation requirements when a pressure ulcer/injury is present. F684 then addresses documentation requirements for any skin ulcer/wound. (3,5)

In addition to the SOM, other regulatory documents, such as the Resident Assessment Instrument (RAI), provide guidance to providers and suppliers on minimum wound documentation and reporting requirements in long term care. As such, it is important to be aware of these various documents and comply with the directions for each. (1,3)

RECOMMENDATIONS: To help ensure compliance regarding care provided, a facility should make sure their documentation meets or exceeds, the requirements set forth in the F686. These requirements can be distilled down into three main elements: assessment, daily monitoring and weekly documentation. It is important that the facility have a system in place to assure that the protocols for daily monitoring and for periodic documentation of measurements, terminology, frequency of assessment, and documentation are implemented consistently throughout the facility for all wound types. The minimum content of each element is outlined below.

F686 – Pressure Ulcers/Injuries

It is important that each existing pressure ulcer/injury be identified, whether present on admission or developed after admission, and that factors that influenced its development, the potential for development of additional injuries or for the deterioration of the pressure ulcer/injury be recognized, assessed and addressed. Any new pressure ulcer/injury suggests a need to reevaluate the adequacy of the plan for preventing pressure ulcers/injuries.

When assessing the ulcer/injury itself, it is important that documentation addresses:

• Type of injury (pressure-related versus non-pressure-related) because interventions may vary depending on the specific type of injury;
• PU/PI’s stage;
• Description of the PU/PI’s characteristics;
• Progress toward healing and identification of potential complications;
• If infection is present;
• Presence of pain, what was done to address it, and the effectiveness of the intervention; and
• Description of dressings and treatments (3)

F684 – Non-Pressure Ulcer/Injury Wounds

Residents may develop various types of skin ulcerations. At the time of the assessment, clinicians (physicians, advance practice nurses, physician assistants, registered nurses and certified wound care specialists, etc.) should document the clinical basis for any determination that an ulcer is not pressure- related, especially if the injury/ulcer has characteristics consistent with a pressure ulcer, but is determined not to be one.

At minimum, documentation should address:​

• Underlying condition contributing to the ulceration
• Ulcer edges and wound bed
• Location
• Shape
• Condition of surrounding tissues (3)

 
It is important that the facility have a system in place to assure that the protocols for daily monitoring and for periodic documentation of measurements, terminology, frequency of assessment, and documentation are implemented consistently throughout the facility. When a pressure injury is present, daily monitoring, (with accompanying documentation, when a complication or change is identified), should include:

• An evaluation of the ulcer, if no dressing is present;
• An evaluation of the status of the dressing, if present (whether it is intact and whether drainage, if present, is or is not leaking);
• The status of the area surrounding the ulcer (that can be observed without removing the dressing);
• The presence of possible complications, such as signs of increasing area of ulceration or soft tissue infection (for example: increased redness or swelling around the wound or increased drainage from the wound); and
• The presence of possible complications, such as signs of increasing area of ulceration or soft tissue infection (for example: increased redness or swelling around the wound or increased drainage from the wound); and
• Whether pain, if present, is being adequately controlled. (3)

The amount of observation possible will depend upon the type of dressing that is used, since some dressings are meant to remain in place for several days, according to manufacturers’ guidelines. With each dressing change or at least weekly (and more often when indicated by wound complications or changes in wound characteristics), an evaluation of the pressure ulcer should be documented.

At a minimum documentation, in the medical records, should include the date observed and:

• Location, wound etiology and/or staging;
• Size (perpendicular measurements of the greatest extent of length and width of the ulceration), depth; and the presence, location and extent of any undermining or tunneling/sinus tract;
• Exudate, if present: type (serous, serosanguinous, purulent, etc.), color, odor and approximate amount;
• Pain, if present: nature and frequency (e.g., whether episodic or continuous);
• Wound bed: Color and type of tissue/character including evidence of healing (e.g., granulation issue), or necrosis (slough or eschar); and
• Description of wound edges and surrounding tissue (e.g., rolled edges, redness, hardness/induration, maceration) as appropriate. (3)

Photographs may be used to support this documentation, if the facility has developed a protocol consistent with accepted standards (e.g., frequency, consistent distance from the wound, type of equipment used, means to assure digital images are accurate and not modified, inclusion of the resident identification/ulcer location/dates/etc. within the photographic image, and parameters for comparison).

​Download this article here.

Dear Partners in Care,

We have seen a tremendous interest in our Quarterly webinars as well as the presentations for some of our corporate clients related to Infection Management and Antibiotic Stewardship. This link and these handouts were mentioned and referenced in one of our last presentations and we wanted to take this opportunity to share them with all of you.

Attached you will find an overview of the: AMT UROLOGICAL, OSTOMY AND TRACHEOSTOMY PROGRAM
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As your trusted partner in the long term care arena we look forward to working with your facility in providing the ultimate experience in both support and education. For further information regarding this new program or wound related questions/education feel free to reach out to your AMT representative.

Have a wonderful week!

“This information is provided for informational purposes only.  Patient management decisions should be based on a number of factors, including (but not limited to) professional society guidelines and published clinical literature relevant to a patient’s condition.  Providers are encouraged to rely on their training and expertise, as well as any and all available information, prior to making management or treatment decisions for any individual patient.”

Lynn Tabor MS, RN, WCC
Director of Education & Training