OASIS Alert

Debridement won’t turn a traumatic wound into a surgical wound.

As a whole, mastering the OASIS integumentary items can seem overwhelming. But if you break down their complexities, it’s easier to address each nuance.

This training tool from Pat Jump, MA, BSN, RN, COS-C, with Rice Lake, Wis.-based Acorn’s End Training & Consulting will provide you with easy steps to take when you identify a wound assessment area that needs improvement

Problem: Lack of knowledge or discomfort about the integumentary OASIS items or difficulty differentiating the various types of wounds.

Solution: These areas require solid training. Make sure you cover the following areas in your training plan:

1. Provide formal training by a wound specialist on a regular basis — at least annually.

2. Distribute and explain the WOCN Society’s Guidance on OASIS-C available at www.wocn.org/?page=oasis.

3. Never assume clinicians are well-versed in wound assessments and documentation of wounds, including OASIS items. Provide refresher training regularly.

Problem: Clients with histories of past Stage 3 and 4 pressure ulcers aren’t being identified.

Solution: Go over best practices for assessing pressure ulcer risk. Be sure to include the following areas:

1. Teach clinicians to observe all areas of the skin.

2. Remind clinicians that stage 3 and 4 pressure ulcers never completely heal and should always be identified when completing the OASIS assessment, including follow-up OASIS assessments.

Problem: Confusion regarding the client’s risk for pressure ulcers.

Solution: Formally train clinicians on the use of pressure ulcer risk assessment tools such as the Braden or Norton scales.

Problem: Uncertainty about when a pressure ulcer is no longer considered a pressure ulcer.

Solution: Provide specific training about muscle flap repair of a pressure ulcer as opposed to a pressure ulcer that has been surgically debrided.

Problem: Confusion regarding what is considered an "ostomy."

Solution: Review the various types of "ostomies" for OASIS reporting purposes. For example, a chest tube is a thoracostomy.

Problem: Uncertainty about documentation of traumatic wounds and surgical wounds.

Solution: Review the OASIS-C guidance manual related to traumatic wounds. Keep the following points in mind when documenting wounds:

1. A traumatic wound does not become a surgical wound because of debridement.

2. A traumatic laceration repaired with plastic surgery is not a surgical wound.

3. Internal trauma repaired by surgery (repair of a torn tendon, repair of a ruptured abdominal organ, or repair of other internal damage) is a surgical wound.

Problem: Inadequate documentation to support the status of various wounds.

Solution: Establish best practice procedures for wound assessment including notation of wound location, size, sinus tracts, tunneling, exudate, necrotic tissue, epithelialization, and presence or absence of granulation tissue.