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We also had a major disagreement about how to stage
wounds. The wound resource nurse staged by NPUAP quidelines and I needed
the MDS definitions. So, we compromised by creating a form that shows the
stages of the wound in 2 columns side by side, one with NPUAP quidelines and one
with the MDS staging. So, we can backstage for MDS and show stage 4 with
all wounds with necrotic eschar. It also shows the survey team what was
going on with the wound, so that the healing process is seen.
----- Original Message -----
Sent: Saturday, February 14, 2004 5:08
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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