Wound staging problem

[Sgibbsrn]

To the Group:      We just had our annual survey.  We are in Tennessee.  State came in two months early this time.  We have  an issue r/t staging of wounds by the wound nurse  and our MDS department.  We don't always agree.  I have told them numerous times in the past that I have to stage a wound with eschar or necrotic tissue as a stage 3 or 4 for MDS purposes and can downstage the wound as it improves.  This does not always agree with their skin reports and how they want the QIs to look.  I am really between a rock and a hard place here.  I have shown them the RAI Manual, etc.  Our main wound nurse is also the ADON of the facility.  Is there anywhere else I can round up information to make them think twice about this and see my point?  I really do not want to be at odds with these people.  I really like the facility and want to continue to work there.  However, I am not inclined to do anything illegal to do so.  They do a good job with staging wounds normally, but we just can't seem to get past this business with the eschar or necrotic tissue.  I don't know why they insist on staging them at all.  I was taught you did not do that because you could not see what was under the eschar, etc.  Any help or info would be greatly appreciated.  You are a great bunch.  Thanks in advance.     Susan Gibbs, RN MDS Coordinator