Re: Surveyors, help more advice needed, re contractures & Section G

[Holly Sox, RN, RAC-C]

Corey, I think part of the problem is the idea of a "generally accepted definition" for contractures.  You are absolutely correct in your thinking. It is also absolutely correct to consider a stage 4 ulcer a stage 4 until it is healed, rather than downstaging it. It would also be absolutely correct to state that someone with dysphagia who can manage a pureed diet with no difficulty has no current swallowing problem.   However, CMS has drafted instructions for completing the survey forms 672 and 802, as well as the MDS, which may not always coincide with our "generally accepted" definitions, but we are essentially bound by them. The surveyor may be incorrect according to the dictionary, but I think the CMS instructions probably trump the English dictionary.        The 672 Instructions state : "The number of residents that have a restriction of full passive range of motion of any joint due to deformity, disuse, pain, etc. Includes loss of range of motion in fingers, wrists, elbows, shoulders, hips, knees, and ankles."   If I have identified any limitation in passive range of motion when I do my contracture assessment, then they go on the 672.   Hope this helps to clarify.   Holly F. Sox, RN, RAC-C  Clinical Editor, Careplans.com www.careplans.com [EMAIL PROTECTED] ----- Original Message ----- From: Corey To: [EMAIL PROTECTED] Sent: Tuesday, December 02, 2003 10:18 PM Subject: Re: Surveyors, help more advice needed, re contractures & Section G Has this changed since I went to nursing school 30 years ago?  I was taught that a contracture was a physical limitation of movement caused by shortening of the tendon which then was compounded in some cases by calcium deposition over the joint.  An inability to voluntary move an extremity was termed paralysis.  A short definition of contracture is "a condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues, supporting the muscles or the joints, or from disorders of the muscle fibres."  That came from the 2002 eDictionary of medical terms, and I'm certain that the paper versions are similar.  The surveyor is incorrect, unless there has been a major change in the definition of contracture lately.    Corey ----- Original Message ----- From: Kathy Archibald To: [EMAIL PROTECTED] Sent: Tuesday, December 02, 2003 7:53 PM Subject: Surveyors, help more advice needed, re contractures & Section G Can someone direct me to generally accepted definition for contractures.  I always thought contractures were irreversible except by surgery.  If we can assist a resident to open his hand, even though the resident can not do it voluntarily due to CVA, I would not have said the resident has a contracture, however the surveyor says no, it is a contracture if the resident can not do it himself.  I understand it is a functional limitation, but not a contracture, or am I splitting hairs???? HELP!