Pressure Ulcer Care in Nursing Homes

1
Pressure Ulcer Care in Nursing Homes

• Qualidigm
• October 2006

2
Our Speakers

• Ann Spenard, MSN, RN C
• Clinical Advisor to the NHQI Project
• Manager of Long-Term Care, DAVE2 Project
• Cathy Milne, APRN, MSN, BC, CWOCN
• Connecticut Clinical Nursing Associates, LLC
• Bristol, Connecticut 06011-1535
• ccna2_at_juno.com

3
Housekeeping

• To minimize background noise
• Please MUTE your phone by pressing 6.
• To UNMUTE your phone for questions, press 7.
• Evaluations
• Will appear on your screen at the end of the
  program.
• Follow Up Conference Call
• Thursday, November 2, 1030 1115 am
• Call in 1-800-914-3396
• Access Code 6133699

4
SET YOUR TARGETS!

• Your quality improvement targets are about to
  expire so set them today!
• www.nhqi-star.org
• Check out the new targets to set!
• PAC Pain, PAC Pressure Ulcers
• Call us if you forgot your log-in/password
  information.

5
NEW!
6
Pressure Ulcers in Connecticut and Coding the MDS

• Ann Spenard, MSN, RN C

7
Pressure Ulcers
8
Coding M1 Ulcers7 Day Look Back

• Intents To record the number of skin ulcers, at
  each ulcer stage, on any part of the body.
• Definition Skin ulcers that develop because of
  circulatory problems or pressure are coded in M1.
  
• Rashes without open areas, burns, desensitized
  skin, ulcers related to diseases such as syphilis
  and cancer and surgical wounds are NOT coded here
  but included in M4.
• Skin tears/shears are coded in Item M4 unless
  pressure was a contributing factor.

9
Coding M1 Ulcers7 Day Look Back

• If necrotic eschar is present prohibiting
  accurate staging, code the skin ulcer as Stage 4.
• Do not code the debrided skin ulcer as a surgical
  wound.
• If a skin ulcer is repaired with a flap graft, it
  should be coded as a surgical wound and not as a
  skin ulcer.
• If the graft fails, continue to code it as a
  surgical wound until healed.

10
Coding M2a7 Day Look Back

• Definition Pressure Ulcer-Any skin ulcer caused
  by pressure resulting in damage of underlying
  tissues.
• Process Review the residents record. Consult
  with the physician regarding the cause of the
  ulcer(s).

11
Coding M2a7-Day Look Back

• Coding Record the highest ulcer stage for
  pressure and stasis ulcer present in the last 7
  days.
• Remember that there are other types of ulcers
  than the two listed in this item (e.g. ischemic
  ulcers).
• An ulcer coded in M1 may not be coded at M2.

12
12.1 High-Risk Residents With Pressure Ulcers

• Numerator Residents with pressure sores M1 a-d
  (stage 1-4) on target assessment
• (M2a 0) You are coding the highest stage
  pressure ulcer here, OR
• I3a-I3e (ICD code area) ICD-9 code of 707.0
• Thos who are defined as high risk (see
  denominator definition)

13
12.1 High-risk Residents With Pressure Ulcers

• Denominator All residents with a valid target
  assessment and any one of the following high-risk
  criteria
• Impaired in bed mobility or transfer on the
  target assessment as indicated by G1aA3,4 or 8
  OR G1bA3,4, or 8.
• Comatose on Target Assessment.
• Suffer malnutrition on the target assessment as
  indicated by the following ICD-9 codes 260, 261,
  262, 263.0, 263.1, 263.2, 263.8, 263.9.

14
12.1 High-risk Residents With Pressure Ulcers

• Exclusions
• Admission assessment.
• Resident is not included in the numerator, and
  M2a is missing on the target assessment.

15
Short-Stay Residents With Pressure Ulcers

• Numerator Short-stay resident at SNF PPS 14-day
  assessment who satisfy either of the following
  conditions
• 1. On the SNF PPS 5 day, the resident had no
  pressure sore (M2a t-10) AND, on the PPS 14
  day, the resident had at least a Stage 1 PU
  (M2at1,2,3 or 4).

16
Short-Stay Residents With Pressure Ulcers

• On the SNF PPS 5-day assessment, the patient had
  a pressure sore (m2at-1 1,2,3, or 4), AND the
  SNF PPS 14-day assessment, pressure sores
  worsened or failed to improve (m2at
  M2at-1).
• Denominator All patients with a valid SNF PPS
  14-day assessment AND valid preceding SNF PPS
  5-day assessment.

This material was prepared and assembled by
Qualidigm, the Medicare Quality Improvement
Organization for Connecticut, under contract with
the Centers for Medicare Medicaid Services
(CMS), an agency of the U. S. Department of
Health and Human Services. The contents
presented do not necessarily reflect CMS policy.
Pub8OWCTNH200628.
17
Questions?
18
Catherine T. Milne APRN, MSN, BC, CWOCN

• Ms. Milne is an Advanced Practice Nurse whose
  role encompasses consultation, research,
  education and direct practice related to patients
  with wound, ostomy and continence care needs in
  ambulatory, extended care, home care and acute
  care settings. She has served as a Principal
  Investigator for several wound care research
  studies, holds academic appointments at three
  universities, and has published articles in her
  area of expertise. Cathy is a clinical reviewer
  for the Journal of Orthopedic Nursing and
  Ostomy-Wound Management Journal. She is a
  co-editor of the recently released Wound, Ostomy,
  and Continence Nursing Secrets book published by
  Hanley and Belfus Medical Publishers.
• Cathy is also co-owner of Connecticut Clinical
  Nursing Associates, LLC, an advanced practice
  nursing consultation, education and direct
  clinical practice agency.