Long-Term Care Survey Alert

The resident's skin may not be clear ... but your survey record can be.

In the survey and malpractice world, you not only have to heal pressure ulcers - you have to prove that you're healing them.

"Facilities that use check sheets with wound measurements may not convey in writing that a wound is actually healing," says Peggy Dotson, RN, principal of Healthcare Reimbursement & Strategy in Yardley, PA.

A wound may look worse and actually increase in size when you use an enzymatic treatment to clean it out, as an example. "So describe the wound, don't just measure it," Dotson advises. "Describe in a standardized way the size of the necrotic tissue - is it the size of a dime, a quarter? Are the wound edges clean with no undermining of the wound? As the wound heals, you should be looking at nice red vascular tissue that's clean."

When pictures aren't worth 1,000 words: Some facilities take pictures of wounds as they heal. But grainy black and white photos may not show healing very well - and can come back to haunt the facility in a lawsuit when a jury sees a series of fuzzy pictures of a serious wound where you can't tell it's improving, warned Mark Heard, MD, CMD, at a recent American Medical Directors Association meeting in Nashville, TN. "So if you're going to chronicle wound healing with pictures, take good color pictures that actually show the wound's progress," he advised AMDA attendees.

Revisit non-healing wounds: If a resident's wound doesn't show signs of healing within two weeks, give the physician a heads up to re-evaluate and change the plan of care, advises Dotson. (The revised survey guidance at F314 advises reassessing the resident's wound and clinical condition if a wound doesn't show evidence of healing within two to four weeks.)