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Susan:
May I make a suggestion? Why not have the
wound nurse stage the wound on the MDS, and sign for section M1, M2. (Or
all of it, if you guys can agree.) That way you aren't in the middle, and the
QI's are the fault of the Wound Nurse when it disagrees with the State Survey
team, and the RAI manual. (On the other hand, more than one nurse has had
to pull the manual and SHOW it to the surveyors: they admit they don't
always understand the MDS)
----- Original Message -----
Sent: Saturday, February 14, 2004 8:08
PM
Subject: Wound staging problem
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
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