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MDS Alert

Quality Assurance:

Keep Your Eye On The QI

Published on Tue Feb 08, 2005

Is that resident really low risk for a pressure ulcer?

When a resident with a pressure ulcer triggers as low risk on the QI, your facility may be looking at an F314 and related F tags.

Remember: Even one resident triggering as low risk on the pressure ulcer QI is a sentinel health event, which surveyors will say should rarely, if ever, occur.

"MDS nurses should keep in mind the items that impact the [risk adjustment] for the pressure ulcer QI and review the supportive documentation to see if they have missed anything," says Pam Campbell, RNC, CRNAC, a consultant with LTC Solutions Inc. in Camendton, MO.

A resident with a pressure ulcer is classified as high risk on the QI if he has one or more of the following MDS items coded:

  •  Impaired bed mobility or transfer ( G1a or b = 3 or 4 in box A). Double check accuracy of bed mobility and transfer scores for a resident who has a pressure ulcer. For example, take a second look at the documentation and re-interview staff to make sure you didn't miss that third instance of weight-bearing support in order to code extensive assistance.

    "But make sure you are obtaining information on events that occurred within the assessment window," Campbell says."During the interview, explain to staff that you are referring to ADL assistance provided within the lookback," she adds.
  • A malnutrition ICD-9-CM diagnosis coded in Section I3 (260, 261, 262, 263, 263.1, 263.2, 263.8, 263.9).

  •  End-stage disease coded at J5c. The latter requires physician-documented certification that the resident has a life expectancy of six months or less.

  •  Comatose (B1=1). All other residents with pressure ulcers on the most recent assessment are classified as being at low risk, according to the quality indicator.

    Tip: The interdisciplinary staff needs to revisit their care planning and systems for each resident who triggers on the pressure ulcer QI - even those classified as being high risk, advise wound-care experts.

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