OASIS Alert

If you don't develop a tool for pressure ulcer staging and verify that all staff is on the same page from the start, you're headed for trouble, says Marianne Rone, RN, BSN, HCS-D, COS-C director of clinical services with Healthcare Provider Solutions in Nashville, Tenn.

Problem: Your nurses have likely all trained at different schools and different times, so what they learned about pressure ulcer staging can vary and cause inconsistencies, Rone says.

Solution: Making the WOCN/NPUAP guidelines your agency's standard for pressure ulcer staging helps to standardize your OASIS-C responses.

Begin this more accurate way of staging pressure ulcers by conducting a training session that covers three key areas, Rone suggests:

• Provide handouts that include the WOCN/NPUAP pressure ulcer staging tool and the OASIS pressure ulcer items.
• Go over each of the words used in pressure ulcer staging and make sure the clinicians all have the same understanding.
• Verify that staff is in synch by putting their staging skills to the test. Gather photographs of pressure ulcers of each stage and project them for staff to see and try their hand at staging. When you discuss the correct staging, you'll verify whether they're following the WOCN/NPUAP guidelines.

Costly mistake: Without a standard agency tool for staging pressure ulcers, two nurses could look at the same pressure ulcer and assign it different stages. This can result in lost case mix points in two ways, Rone says. You could incorrectly report the ulcer at a lower stage and miss out on points that way. Or you could submit your OASIS with the ulcer at a higher stage than it actually is and have points taken away under medical review.