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42CFR483.25(c), F 314
Based on the comprehensive Assessment of a resident, the facility must ensure that- -
(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable
Intent: �483.25(c)
The intent of this regulation is that the resident does not develop a pressure sore while in the facility. If
the resident is admitted with or develops a pressure sore, he or she receives care and treatment to
heal and prevent further development of pressure sores.
Procedures: �483.25(c)
Identify if resident triggers RAPs for urinary incontinence, nutritional status, cognitive loss/dementia,
psychotropic drug use, and physical restraints. Consider whether the RAPs were used to assess causal factors for decline, potential for decline or lack of improvement.
If the resident is moribund (i.e., the resident is terminally ill; semi - comatose or comatose) and life -
sustaining measures have been withdrawn or discouraged as documented in the record, pressure
sores may be clinically difficult to prevent.
A determination that development of a pressure sore was unavoidable may be made only if routine
preventive and daily care was provided. Routine preventive care means turning and proper
positioning, application of pressure reduction or relief devices, providing good skin care (i.e., keeping
the skin clean, instituting measures to reduce excessive moisture), providing clean and dry bed
linens, and maintaining adequate nutrition and hydration as possible.
Clinical conditions that are the primary risk factors for developing pressure sores include, but are not
limited to, resident immobility and:
1. The resident has two or more of the following diagnoses:
a. Continuous urinary incontinence or chronic voiding dysfunction;
b. Severe peripheral vascular disease;
c. Diabetes;
d. Severe chronic pulmonary obstructive disease;
e. Severe peripheral vascular disease;
f. Chronic bowel incontinence;
g. Continuous urinary incontinence or chronic voiding dysfunction;
h. Paraplegia;
i. Quadriplegia;
j. Sepsis;
k. Terminal cancer;
l. Chronic or end stage renal, liver, and/or heart disease;
m. Disease or drug-related immunosuppression; or
n. Full body cast.
2. The resident receives two or more of the following treatments:
a. Steroid therapy;
b. Radiation therapy;
c. Chemotherapy;
d. Renal dialysis; or
e. Head of bed elevated the majority of the day due to medical necessity.
3. Malnutrition/dehydration, whether secondary to poor appetite or another disease
process, places resident at risk for poor healing, and may be indicated by the following lab values:
a. Serum albumin below 3.4 g/dl
b. Weight loss of more than 10% during last month
c. Serum transferrin level below 180 mg per dl
d. Hgb less than 12 mg per dl.
Use these values in conjunction with an evaluation of the resident's clinical condition.
4. If laboratory data are not available, clinical signs and symptoms of malnutrition/dehydration
may be:
a. Pale skin;
b. Red, swollen lips;
c. Swollen and/or dry tongue with scarlet or magenta hue;
d. Poor skin turgor;
e. Cachexia;
f. Bilateral edema;
g. Muscle wasting;
h. Calf tenderness; or
i. Reduced urinary output.
Probes: �483.25(c)(1)
For each sampled resident selected for the comprehensive review, or the focused review at risk of
developing pressure sores, determine, as appropriate, if aggressive preventive care is provided?
For sampled residents, who upon initial admission to the facility, did not have a pressure sore and
now have one, determine if pressure sore development may have been avoided:
o Did the facility identify the resident as being at risk for pressure sore(s)?
o Did the facility provide aggressive/appropriate preventive measures and care specific to
addressing the resident's unique risk factors (e.g., if serum albumin is below 3.4 mg per dl,
provide additional protein in daily snacks)?
o Was this preventive care plan implemented consistently?
>>
This F-Tag also addresses care of residents with pressure ulcers, provides definitions, etc. Check it out at http://cms.hhs.gov/manuals/pub07pdf/AP-P-PP.pdf
Rena
Subj: RE: AVOIDABLE?
Date: 11/19/03 5:34:35 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
This "Unavoidable Pressure Ulcer" assessment/classification is a new concept for me. What are you using this for? Any information on this particular documentation would be appreciated. Thank you in advance.
Holly QI in CT
>-----Original Message-----
>From: Corey [SMTP:[EMAIL PROTECTED]
>Sent: Tuesday, November 18, 2003 8:27 PM
>To: [EMAIL PROTECTED]
>Subject: Re: AVOIDABLE?
>
>It was attached to the original message from Mike. I am copying it into this email from Word, and I will attach a copy as well, just in case you can't get attachments.
>
>Resident> '> s Name: _________________________________
>
>UNAVOIDABLE PRESSURE ULCER
>
>RISK ASSESSMENT CRITERIA
>
>Clinical conditions that are PRIMARY RISK FACTORS for developing pressure
>
>sores include, but are not limited to immobility and:
>
>The resident has two or more of the following diagnoses:
>
>____ Continuous Urinary Incontinence or Chronic Voiding Dysfunction
>
>____ Severe Peripheral Vascular Disease
>
>____ Diabetes
>
>____ Severe Chronic Bowel Incontinence
>
>____ Paraplegia
>
>____ Quadriplegia
>
>____ Sepsis
>
>____ Terminal Cancer
>
>____ Chronic or End Stage Renal, Liver and/or Heart Disease
>
>____ Disease or Drug related Immunosuppression
>
>____ Full Body Cast
>
>____ Semi-comatose or Comatose
>
>The resident receives 2 or more of the following treatments:
>
>____ Steroid Therapy
>
>____ Radiation Therapy
>
>____ Chemotherapy
>
>____ Renal Dialysis
>
>____ Head of Bed elevated the majority of the day due to medical necessity.
>
>Malnutrition/dehydration whether secondary to poor appetite or another disease
>
>Process, places resident at risk for poor healing and may be indicated by the
>
>Following lab values:
>
>____ Serum Albumin below 3.4 g/dl
>
>____ Weight Loss of more than 10% during the last 30 days
>
>____ Serum Transferrin level below 180 mg/dl
>
>____ Hgb less than 12 mg/dl
>
>Use these values in conjunction with an evaluation of the resident> '> s clinical
>
>condition. If lab data are not available, clinical signs and symptoms of
>
>Malnutrition, dehydration may be:
>
>____ pale skin
>
>____ red, swollen lips
>
>____ swollen and/or dry tongue with scarlet or magenta base
>
>____ cachexia
>
>____ bilateral edema
>
>____ muscle wasting
>
>Cont> '> d
>
>____ calf tenderness
>
>____ Sunken eyes and/or cracked lips
>
>____ reduced urinary output
>
>PREVENTIVE MEASURE IMPLEMENTED
>
>Pressure relief surface: ___________________________________________________
>
>Additional protective equipment: ____________________________________________
>
>Nutritional Supplements: __________________________________________________
>
>Vitamin/mineral supplements: _______________________________________________
>
>History of healed pressure ulcer(s): __________________________________________
>
>Mental Status: ________________________ Mobility: _________________________
>
>Resident> '> s compliance with treatment plan: ____________________________________
>
>Resident> '> s Name: _____________________________________ Braden Scale: ______
>
>Date: __________________
>
>Physician> '> s Signature: ________________________________ Date: ______________
>
> ----- Original Message -----
> From: Colleen Wolf <mailto:[EMAIL PROTECTED]>
> To: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]>
> Sent: Tuesday, November 18, 2003 6:03 PM
> Subject: Re: AVOIDABLE?
>
>
> May I also get that? Please fax to (605)338-2351. Colleen-RN, MDS Coordinator
>
>
>
>
>
> ----- Original Message -----
> From: Mike Muniz <mailto:[EMAIL PROTECTED]>
> To: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]>
> Sent: Tuesday, November 18, 2003 11:23 AM
> Subject: Re: AVOIDABLE?
>
> try this one
>
>-------Original Message-------
>
>From: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]>
>Date: Tuesday, November 18, 2003 10:33:54
>To: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]>
>Subject:> AVOIDABLE?
>
>Does anyone have an investigation form for avoidable vs. unavoidable pressure areas that they may be willing to share?
>
>You can email it to me or fax @410-689-2771
>
>Thanks in advance,
>
>Glenn Barnes RAC-C
>
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Healthcare Consultant
