OASIS Alert

Don't 'downstage' your patients' pressure ulcers.

Question: A patient entered our care with Stage II pressure ulcer that has now begun to heal. Can we change the stage of healing to Stage I?

Answer: You can't "downstage" or "reverse stage" pressure ulcers or other wounds, says the Laguna Beach-based Wound, Ostomy and Continence Nurses Society (WOCN), which the Centers for Medicare & Medicaid Services names as a key resources for wound staging along with the National Pressure Ulcer Advisory Panel.

"Pressure ulcers heal to progressively more shallow depth," but the original, healthy tissue is replaced with granulation tissue rather than normal tissue -- meaning a Stage IV ulcer can never become a Stage III, NPUAP explains.

Strategy: When a Stage IV pressure ulcer is partially healed, you should code it as "healed Stage IV" rather than simply re-staging it, WOCN states.

Caveat: Stage I and II wounds do have the potential to heal, according to the OASIS Implementation Manual of January 2008. However, you should follow the same rules as with more serious ulcers. So, rather than downstaging a Stage II to a Stage I as it heals, you should code it as a "healed Stage II."

"All agencies must ensure that their clinicians are educated on all information, guidance and guidelines which are documented as references" by CMS for OASIS, urges Marianne Rone, RN, director of clinical services for Healthcare Provider Solutions in Nashville, Tenn.

And CMS' reliance on WOCN and NPUAP is unlikely to waver after OASIS-C is finalized, Rone says. "These organizations will provide additional information to assist clinicians in documentation, not necessarily changes," Rone predicts.

Note: You can view WOCN's wound staging advice at www.wocn.org/pdfs/WOCN_Library/Position_Statements/PressureUlcerStaging.pdf and NPUAP's guidance is at www.npuap.org/positn5.htm.