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Holly,
Here's my thinking on the
issue. The writer stated the following:
>>"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."<<
Therefore, the patient has lost ACTIVE ROM, but has
full PASSIVE ROM, correct? The rules for the 672 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."<<
Per the definition of the 672 (or any other
definition for a contracture) the patient has passive ROM and therefore does NOT
have a contracture, and the surveyor is dead wrong. If you think I'm off
here, please explain it to me logically, because even reading the CMS directions
indicates that their surveyor was confusing ACTIVE ROM (which the patient did
not have) with PASSIVE ROM, which the patient still had remaining, if the nurses
can assist the patient to open his hand.
Corey
----- Original Message -----
Sent: Wednesday, December 03, 2003 6:52
AM
Subject: Re: Surveyors, help more advice
needed, re contractures & Section G
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.
----- Original Message -----
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 -----
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!
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