"Other factors cause pressure ulcers, too. If a person slides down in the bed or chair, blood vessels can stretch or bend and cause pressure ulcers. Even slight rubbing or friction on the skin may cause minor pressure ulcers."
Rena
Subj: Re: skin tears
Date: 1/8/04 8:21:34 AM Pacific Standard Time
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Rena,
I must admit that this situation really confuses me. CMS removed the paragraph at the bottom of page 3-160 from the manual with their August update. That was the paragraph that discussed a resident receiving a skin tear while being pulled up in bed and called it a pressure ulcer. They also removed the word "injury" from the definition of ulcer. They did keep in The last 2 sentences on page 3-162 which speaks about a person sliding down in bed, causing blood vessels to break and therefore causing a pressure ulcer. It all doesn't really add up to me. I would consider a skin tear from a resident being pulled up in bed as an "injury". If CMS wanted the skin tears from being moved around in bed coded as ulcers, why did they remove the paragraph from 3-160?
I had been teaching to code skin tears from friction as ulcers before August, but stopped in August when the updates came out. I have no problem with unrelieved pressure as a pressure ulcer and understand about the cuts from pinches not being ulcers, but can't seem to justify the difference between a cut from being quickly being pulled up in bed and one from a finger being pinched in a drawer as very much different. Any light you could shine on the subject would be very much appreciated.
Thanks,Carol
-----Original Message-----
From: [EMAIL PROTECTED]
Sent: Jan 8, 2004 7:43 AM
To: [EMAIL PROTECTED]
Subject: Re: skin tears
The pressure point really isn't the issue.
Determine the cause of the tear. If unrelieved pressure (as opposed to the kind of pressure that results from slamming your hand against the wall, for example), such as friction from sliding down in bed (see page 3-162 of the RAI User's Manual) contributed to the tearing of the skin, then it is staged in M1. If you really are unable to determine the cause of the wound, then it is important to look at the location of the wound, the resident's mobility status, etc., and make a clinical judgment about whether it is likely that pressure was a contributing factor.
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: skin tears
Date: 1/8/04 4:34:03 AM Pacific Standard Time
From: [EMAIL PROTECTED]
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Please tell me if I am correct in my thinking. When you have a skin
tear that is not on a pressure point. I do not have to stage it in
section M1. I would only put it in M3.
Thanks,
Billie Stewart, RNAC
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