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

• Recognize nutritional challenges facing patients, residents and staff during the COVID-19 pandemic.
• Effectively address unintended weight loss and non-healing wounds with appropriate nutrition interventions.
• Discuss the role of protein and amino acids in wound healing.

FACULTY:
Dr. Nancy Collins. PhD, RDN, LD, NWCC, FAND is a wound care certified registered dietitian who is internationally known for her expertise in the complex relationship between malnutrition, body composition, and tissue regeneration. Dr. Collins has over 25 years of hands-on practitioner experience in clinical nutrition and industry consulting and is the founder of Nutrition411.com.

MODERATOR:
Pamela Scarborough, PT, DPT, MS, CWS, CEEAA is board certified wound specialist currenting providing education, mentoring and leadership for the long-term, post-acute care industry in wound prevention and management from both clinical and regulatory perspectives. Dr. Scarborough stays current on this and related topics and passes on knowledge that serves clinicians, patients and residents in this specialty area of care, chronic wounds.

​Objectives:

• List common issues that can lead to chronic venous insufficiency and wounds.
• Identify assessment considerations for venous leg ulcers.
• Verbalize treatment interventions that meet, or do not meet, best practice.

• Will there be an influx of people who have been on ventilators, are now recovering and will need skilled care?
• Will there be an influx of people who are recovering from COVID that need skilled care?
• Are SNF’s adapting to serve the changing population, for example set up COVID wings?
• In states that are not seeing high numbers of COVID cases, will these states initiate elective surgeries earlier, if so when?
• In states that are seeing higher volumes of COVID cases, what has there been any discussion as to when elective surgeries will be resumed? 
• Prior to COVID, what percentage of elective surgeries resulted in skilled stays for rehabilitation services?  In the future, do we anticipate this to be the same, or decrease?
• Are you experiencing staffing shortages due to the coronavirus in your facilities?  If so, what mitigation steps have you put into place in an effort to prevent pressure injuries?

​
Our healthcare world has certainly changed.  Partnership, community and collaboration are imperative as we navigate these new waters together.  I look forward to hearing your replies!
​

Sarah holds a Bachelor of Science in Physical Therapy from and has been an adjunct faculty at Northeastern University, assisting with developing and lecturing the wound care curriculum.  She has also been a guest speaker for various organizations focusing on the area of wound care and management.

SEMINAR DESCRIPTION
​
Long-term care buildings are having to admit sicker, frailer individuals than ever before in the 60-year history of this industry. The increased level of ill-health in our population with multiple comorbidities means our residents and patients are at greater risk for pressure ulcer/injuries (PU/PI) than in years past. Due to the higher acuity of facility admissions your clinical team needs to determine: “Is this resident’s wound actually due to pressure, or is it a Kennedy Terminal Ulcer a.k.a. Skin Failure” due to the multiorgan failure and the dying process?
​
This seminar will review business, clinical and regulatory components for prevention, treatments and reporting of skin issues with a focus on PU/PI prevention. The importance of staging for documentation and coding on the MDS for appropriate PDPM reimbursement will be reviewed. In addition, there will be focused content on the Root Cause Analysis (RCA) process, the construct CMS recommends buildings use as part of the QAPI process for the internal investigation of facility acquired PU/PIs. This RCA process will assist facilities in identifying the KTU from the avoidable PU/PI and will find the gaps in your PU/PI prevention program. Join us for this information-packed seminar to improve the clinical, reimbursement, and regulatory aspects of your building’s/organization’s wound prevention and management programs.

EDUCATIONAL COMMITMENT
​
This course is offered without charge to participants as part of AMT’s educational commitment to long-term care facilities across the United States.

Diabetes is one of the most complicated and costly diseases of the 21st century. Many of our residents and patients in the long-term care setting have diabetes, which may cause complications such as diabetic foot ulcers and interfere with the healing of other chronic wounds etiologies. This program will discuss diabetes and wound healing in general, and how the foot is affected by the disease. Prevention, assessment and treatment strategies for diabetic foot ulcers will be included in the content. 

OBJECTIVES:

• Identify the Standards of Practice for assessment and prevention of diabetic foot ulcers
• Discuss care practices to intervene for at risk feet for diabetic foot ulcers
• List treatment interventions for care of diabetic foot ulcers​

What Is Pressure Injury
A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue. The full list of NPIAP pressure injury definition stages can be found here.

What We Know
Promoting a “prevention mindset” for you staff is key in preventing pressure injuries and reducing the financial burden caused by pressure injuries.  The goal is to keep the Resident moving as much as possible increasing blood flow, while reducing shearing and friction forces. Consistent, good skin care is just as important.  Keeping the skin clean, dry, and moisturized, while managing the microclimate will promote quality skin care management. The pressure injury prevention list can be found here.

Remove the Cause
Pressure Injuries can develop at any age, but more commonly it is the senior population that uses wheelchairs, is bedbound and wears medical devices and who, are therefore at highest risk. If a pressure injury does develop, you first want to identify the cause while using a holistic approach. You will want to investigate the cause from every angle. Until the cause of the pressure injury is removed, the pressure injury will not heal. Encourage your nursing staff to focus more on a prevention mindset while encompassing ongoing education.

Description:
The documentation requirements for Medicare reimbursement of durable medical equipment (DME) can be overwhelming. Having the necessary documentation is a shared responsibility between the clinical community and the DME suppliers.

​Join the DME MACs to learn more about these documentation requirements as they pertain to beneficiaries with wounds. This training will focus on the types of dressings covered by Medicare as well as the documentation required by the treating clinician/practitioner.

Pressure Ulcer/Injury Prevention & Wound Care in Long-term Care Setting: Meeting Regulatory & Clinical Guidelines

​This information-packed, full-day seminar will provide up-to-date evidence-based recommendations and CMS mandated regulations for pressure ulcer prevention, recognition, assessment, and treatment. In addition, the most frequent non-pressure etiologies (e.g. venous and arterial insufficiency, diabetic neuropathic foot ulcers, and skin tears) will be reviewed.

Focused content on the Unavoidable Pressure Ulcer aka the Kennedy Terminal Ulcer/Skin Failure will be included to assist buildings in recognizing skin failure at life’s end for the clinical team to address Quality of Life issues for residents with these unavoidable pressure ulcer/injuries. The regulatory focus of the course will be on F-Tags F684, F686, and F687. This is a basic to intermediate level course and is appropriate for the new wound care clinicians and seasoned wound management providers.

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

Seminar Faculty:
Pamela Scarborough, PT, DPT, MS, CWS, CEEAA, Director Of Public Policy & Education, AMT

Registration:
This course is presented without charge as part American Medical Technologies’ educational commitment to long-term care facilities across the country. AMT Education Division is a provider of Continuing Nursing Education by the California Board of Nursing. Provider Number CEP 15291. This seminar is approved for 6.0 hours of continuing education for nurses.

Web-registration is now closed for this educational event. To request registration or other questions about this event, please call Beth Sherman at 412-699-0425.

Description
​This program will address pressure ulcer prevention and management risks from the legal, clinical standards of practice, and regulatory perspectives, providing content that addresses a building’s Pressure Ulcer/Pressure Injury prevention program from a system’s perspective and as a component of the Quality Assessment and Performance Improvement (QAPI) process. In addition, content will include a thorough review of coding mandates and tips from Section M of the MDS. Correct coding of the MDS is a primary factor of the new PDPM system of reimbursement.
​
This program is basic to intermediate level, appropriate for the Nursing Directors, Treatment Nurses, interdisciplinary clinical leadership, MDS coordinators, and others responsible for ensuring clinical practice standards and regulatory mandates are in place for their buildings.

Debridement is a fundamental component of wound management and a standard of practice. Preparing the wound bed for healing must be done adequately to facilitate the best outcomes and provide opportunities for closure and subsequent healing.
​
This program will discuss the: Who, When and How components of chronic wound debridement — specifically for the population residing in the long-term care setting. Content will include assessment prior to debridement (e.g., vascular studies to the lower extremity), types of debridement and precautions/contraindications of debridement. Attend this session to better recognize which wounds will benefit from debridement and how to best accomplish this in the long-term care setting.

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

• Discuss debridement as a component of the Wound Bed Preparation paradigm;
• Recognize when and what to debride from the wound;
• Identify precautions and contraindications for debridement;
• Verbalize the different types of debridement.

AMT Education Division is a provider of Continuing Nursing Education by the California Board of Nursing, Provider Number CEP 15291. This program is approved for 1 nursing contact hour by the California Board of Nursing.

Description
​This program will address pressure ulcer prevention and management risks from the legal, clinical standards of practice, and regulatory perspectives, providing content that addresses a building’s Pressure Ulcer/Pressure Injury prevention program from a system’s perspective and as a component of the Quality Assessment and Performance Improvement (QAPI) process. In addition, content will include a thorough review of coding mandates and tips from Section M of the MDS. Correct coding of the MDS is a primary factor of the new PDPM system of reimbursement.
​
This program is basic to intermediate level, appropriate for the Nursing Directors, Treatment Nurses, interdisciplinary clinical leadership, MDS coordinators, and others responsible for ensuring clinical practice standards and regulatory mandates are in place for their buildings.

Carla Kitten is the Regional Clinical Manager of the West Coast for American Medical Technologies. She is a master’s prepared registered nurse with over 35 years’ experience in nursing. Specialty areas include over 10 years in the legal nurse consulting arena serving both plaintiff and defense firms, over 10 years in critical care and the emergency department, and 15 years in the area she is most passionate about, nursing education and wound care. ​

AMT has partnered with Durable Medical Equipment Medicare Administrative Contractors (DME MACs), Noridian Healthcare Solutions and CGS Administrators, to host a live educational webinar covering Medicare’s documentation requirements for wound care residents.

Documentation is a critical component of resident care. To help ensure regulatory compliance regarding wound care provided, a facility should make sure their documentation meets or exceeds the requirements set forth by Medicare. This webinar is developed to help participants learn critical information that they can apply directly within their facilities.

Trina St. Ours - Education Consultant DME Outreach and Education with Noridian Healthcare Solutions along with Michael Hanna MPA, CDME - Provider Relations Senior Analyst with CGS Administrators will present their insights. This presentation will be focused on the long-term care facilities’ responsibilities in creating/maintaining the necessary documentation for reimbursement of surgical dressings and supplies. Emphasis and specific detail will be provided on preliminary orders, detailed written orders and the importance of thoroughly completed monthly/weekly evaluations. ​

Webinar registration is free and Continuing Education (CE) credits will be available for attendees of the live webinar.  A recorded version of the presentation will also be provided for those unable to attend the live event.

Seminar Focus:
​Wound Prevention and Management in the Post-Acute, Long-Term Care Setting: Meeting the Clinical and Regulatory Guidelines and Mandates

Providing wound prevention and management in the long-term, sub-acute care setting is challenging for many reasons including, but not limited to; the population (older and/or more acute than years past), the regulations, reimbursement constraints, and clinical knowledge challenges regarding this mammoth topic.  For all these reasons, and more, wound care in the PAC/LTC is demanding for building management, leadership, and clinical and support staff.

​This program will integrate clinical best practices with regulatory (survey) and reporting (MDS, Section M) mandates for wound prevention and care, providing the attendees with up to date information to assist clinical teams, building management and leadership with tools and direction for creating functional wound prevention and care programs.  This course will support the PDPM and QAPI mandates by CMS related to skin integrity.

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

• Recognize the most common chronic wound etiologies including pressure injuries/ulcers
• Discuss pressure ulcer prevention strategies using a systems approach
• Identify MDS reporting mandates using Section M Coding instructions for reporting wound etiologies including pressure ulcer/injuries and other common wound etiologies
• Describe current treatment interventions for chronic wounds including: debridement, topical therapies, and biophysical agents (e.g. NPWT, E-Stim)
• List resources to assist in framing your wound prevention and management program

 
Content Includes:

• Review of most the common wound etiologies
• Pressure ulcer prevention program process design
• MDS Section M Reporting mandate including detailed descriptions and coding tips for staging and documentation
• Prevention and treatment interventions that meet practice standards and regulatory mandates
• Review of core resources for framing a functional wound prevention and management program.

  
​Course Faculty:
Dr. Pamela Scarborough is the Director of Public Policy and Education for American Medical Technologies. Her clinical career spans more than 35 years, having practiced in a variety of settings including acute, outpatient, home health, and long-term care. Her clinical experience has included traditional physical therapy, orthopedics and sports medicine, cardiac rehabilitation, and wound management. Pamela has published book chapters, articles, and monographs on the topics of diabetes and wound care, in addition to being a highly sought-after speaker, invited to present to interdisciplinary audiences at conferences, on webinars, and at wound management educational activities around the country. Her focus is currently clinical best-practices and CMS regulatory components for wound prevention and management in the long-term care setting.

Course Description:
This information-packed, one-day seminar provides participants current up-to-date information regarding recognition, assessment, and treatment of lower extremity and foot wounds from common etiologies such as arterial and venous insufficiency, diabetic neuropathic foot ulcers, and lymphedema.

​Content includes information on how the disease state of diabetes impacts all wound etiologies. The skills lab portion of the course provides attendees with hands-on training in Doppler screening, sensory testing, and other tests and measures commonly used for lower extremity and foot examinations. In addition, a compression skills lab for kinesthetic learning of multi-layer compression wrap application for treatment of venous insufficiency wounds will be offered. This is a basic to intermediate level course. ​

Course Faculty:
Dr. Pamela Scarborough is the Director of Public Policy and Education for American Medical Technologies. Her clinical career spans more than 35 years, having practiced in a variety of settings including acute, outpatient, home health, and long-term care. Her clinical experience has included traditional physical therapy, orthopedics and sports medicine, cardiac rehabilitation, and wound management. Pamela has published book chapters, articles, and monographs on the topics of diabetes and wound care, in addition to being a highly sought-after speaker, invited to present to interdisciplinary audiences at conferences, on webinars, and at wound management educational activities around the country. Her focus is currently clinical best-practices and CMS regulatory components for wound prevention and management in the long-term care setting.

This course is presented without charge as part American Medical Technologies’ educational commitment to long-term care facilities across the country.
​
AMT Education Division is a provider of Continuing Nursing Education by the California Board of  Nursing.  Provider Number CEP 15291. This seminar is approved for 6.0 hours of continuing education for nurses.

This information-packed, full-day seminar will provide up-to-date evidence-based recommendations and CMS mandated regulations for pressure ulcer prevention, recognition, assessment, and treatment. In addition, the most frequent non-pressure etiologies (e.g. venous and arterial insufficiency, diabetic neuropathic foot ulcers, and skin tears) will be reviewed. Focused content on the Unavoidable Pressure Ulcer aka the Kennedy Terminal Ulcer/Skin Failure will be included to assist buildings in recognizing skin failure at life’s end for the clinical team to address Quality of Life issues for residents with these unavoidable pressure ulcer/injuries. The regulatory focus of the course will be on F-Tags F684, F686, and F687.
​
​This is a basic to intermediate level course and is appropriate for the new wound care clinicians and seasoned wound management providers.

Our Commitment:
This course is presented without charge as part of  AMT’ educational commitment to long term care facilities across the country. AMT Education Division is a provider of Continuing Nursing Education by the California Board of Nursing. Provider Number CEP 15291.

This seminar is approved for 6.0 hours of continuing education for nurses.

​Pressure ulcer/injury (PU/PI) prevention is considered a quality measure in most care settings—including long-term nursing facilities. To comply with federal regulations, a facility must demonstrate, through the resident assessment processes, care plan documentation and clinical outcomes, that the only facility acquired PU/PIs are unavoidable. Providing this level of care (prevention of all PU/PIs, except those produced by the resident’s failing physiology) requires that the facility have processes and protocols in-place to move the entire staff towards the goal of PU/PI prevention.
 
The faculty of this webinar will use a Self-Assessment Worksheet to help facilities identify current processes, gaps and places for improvement. Whether a facility has a root cause analysis program firmly in-place, are just beginning, or are working toward their PU/PI Quality Assurance and Performance Improvement process, this program has content to help inform and support the goal of PU/PI prevention.

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

• Identify which tools and processes are currently in place to identify residents who have PU/PI risk, or experience a change in PU/PI risks;
• Discuss current PU/PI prevention practices in their building/company; 
• Recognize gaps in current PU/PI prevention practices/processes;
• Formulate plans to improve pressure ulcer/injury prevention practices/processes and improve clinical interventions and outcomes

• ​Title: MDS, Section M Updates, Hints and Tips
• Date: Thursday, December 6, 2018
• Time: 2:00 – 3:15 pm Eastern
• Download flyer: Click here
• Register: Click here

The MDS, Section M has been updated as of October 1st, 2018. New pressure ulcer/injury definitions and staging descriptions have been adapted by CMS from the National Pressure Ulcer Advisory Panel and included in the updated Resident Assessment Instrument for coding the M-Section. 

Attend this 90-minute fast-paced, information-packed webinar to get up to speed on the new reporting mandates and the most frequent mistakes when reporting wounds, including pressure ulcer/injuries to CMS. In addition, you are invited to be part of this interactive program where you may bring your questions about the M-Section or add your knowledge and understanding to the discussion.

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

• Identify the most common mistakes when reporting pressure ulcer/injuries and other wound etiologies on the MDS, Section M.
• Verbalize the new pressure ulcer staging descriptions from the Resident Assessment Instrument for coding and reporting pressure ulcer/injuries for Section M.

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

​
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.

​

• ​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.

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).

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