Now’s the time to polish up your pressure ulcer assessment.
The newly-revealed OASIS-C2 makes it clear that the Centers for Medicare & Medicaid Services still has its sights set on pressure ulcers. Make certain your OASIS responses and assessment approach don’t put your agency in the quality crosshairs.
Background: In late 2015 CMS issued the new OASIS-C2 assessment tool. The form is updated “to comply with requirements for standardized, cross-setting measures for post-acute care under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014,” CMS noted on its website.
Among the new items and other changes to the OASIS document are updates to wound items designed to comply with the IMPACT Act, which aims to standardize data collection across the post-acute provider continuum.
“Continuity of care to ensure patient needs are being met across Post Acute Care (PAC) settings has become a priority,” says Sue Kennedy, BS, RN, CWOCN, FACCWS, COS-C, with RitKen and Associates, a nationwide WOC Nurse consulting firm based in Ponchatoula, La. “Additionally, payment reimbursement will be impacted according to reported patient outcomes.”
While the OASIS already collects information about patient skin integrity, a new quality measure focusing on this area is behind the OASIS-C2 pressure ulcer item changes. Skin integrity is already a part of the quality measure reporting for Long Term Care Hospitals, Skilled Nursing Facilities and Inpatient Rehab Facilities. Home care providers will join these other post-acute providers with a skin integrity quality measure beginning in 2017.
Know What You Can Do to Prepare
The new quality measure doesn’t go into effect until 2017, but there are some steps you can take to improve patient care and prevent any negative impact on your agency. Consider the following tips from Kennedy and Debbie Ritter, BSN, RN, CWOCN, FACCWS, COS-C, also with RitKen.
Another key to success with the skin integrity quality measure will be making certain clinicians perform a thorough pressure ulcer assessment and implement any appropriate interventions. Give clinicians a refresher to make sure they know the following, Kennedy and Ritter suggest.
o Stage I is intact skin with non-blanchable erythema.
A Stage II pressure ulcer will not have slough or granulation.
o Stage III and Stage IV involve full thickness tissue damage.
Presence of slough or granulation indicate full thickness tissue damage.
o Suspected deep tissue injuries. Intact skin that has a purplish, maroon, or bruised appearance that is located over a bony prominence may be a suspected deep tissue injury. A blood filled blister caused by unrelieved pressure or shear would be considered a deep tissue injury.
Follow these Pressure Ulcer Item Tips
The OASIS pressure ulcer items are some of the trickiest to answer correctly. Although these questions have undergone many changes over the years, they can still give even the most seasoned clinicians some difficulty. Keep the following tips from Kennedy and Ritter in mind as you answer these items that will gather data for the skin integrity quality measure.
M1308 — Current Number of Unhealed Pressure Ulcers at Each Stage or Unstageable:
M1309 — Worsening in Pressure Ulcer Status since SOC/ROC:
Note: Review the OASIS-C2 on the CMS Home Health Quality Initiative website under the downloads section here: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/OASIS-C2-Item-Set-Effective-1-1-17-.pdf.
Watch for: M1311 will add the prompt “Number of These Stage ___ Pressure Ulcers That Were Present at Most Recent SOC/ROC” for each subitem.
o Stage II involves only partial thickness tissue loss.
Stage II pressure ulcers heal, they most likely will not have a scar.
Stage III and Stage IV pressure ulcers do not “heal,” they “close.”
A scar will be present when a Stage III or Stage IV pressure ulcer closes.
A closed Stage III or Stage IV pressure ulcer will break down more quickly with unrelieved pressure since “tensile strength” is less than original skin integrity structures.