[PattiRN]

YES IT IS THAT DARN SKIN AND LESION QUESTION ON OASIS....MY QUESTION IS ARE ALL OF YOU NURSES ANSWERING THIS YES AS THE INSTRUCTIONS SAY THAT LESIONS ARE SCARS AND MOLES, ETC. AND EVERYONE I KNOW HAS A MOLE OR A SCAR. OR ARE YOU ONLY ANSWERING THIS YES IF THE CLIENT HAS AN OPEN WOUND?

[Emmes]

Patti,
I work on a Quality team in homecare. We have an Oasis "guru" of sorts named Beacon Health....they tell us anything from a mole, old scar, even a freckle or dandruff constitutes a skin lesion. We have all our nurses answer M0440 yes for any of the above items noted during assessment. It tacks on a point or two for the HHRG total score. I know it seems ridiculous that any of these items would be considered a skin lesion, but we're talking about the government and it's regulation of healthcare!!

[Traveler]

I'm not looking at a HHRG sheet now, but doesn't the HHRG increase only if there is an open wound AND the primary diagnosis is trauma r/t the wound? This is what I was led to believe. I would love to know if I have been doing this wrong.

[NRSKarenRN]

Check out the 3M National OASIS Integrity Project
Recommended Questions and Techniques for OASIS M0 Items

MO440 on pg 48:

Item Clarification: Identifies the presence of a skin lesion or open wound. A lesion is a broad term used to describe an area of pathologically altered tissue. Sores, skin tears, burns, ulcers, rashes, surgical incisions, crusts, etc. are all considered lesions. All alterations in skin integrity are considered to be lesions, except alterations that end in "ostomy" (e.g., tracheostomy, gastrostomy, etc.) or peripheral IV sites. Persistent redness without a break in the skin is also considered a lesion.

Recommendations from Expert Design Forum
Optimal Question: Do you have any wounds, sores, scars (use word they can understand)?

Optimal Technique: Visually inspect skin.

Tips:

Skin lesion

•

Area of pathologically altered tissue

• Primary lesions (arising from previously normal skin) such as vesicles, pustules, wheals.
• Secondary lesions (resulting from changes in primary lesions) such as crusts, ulcers, scar.

•

Changes in color or texture such as maceration, scale, lichenification

•

Changes in shape of skin surface such as edema, cyst, nodule

• Breaks in skin surfaces such as abrasion, excoriation, fissure, incision.

• Vascular lesions such as petechiae, ecchymosis.

Includes but not limited to:

• Wounds, ulcers, rashes, crusts, bruises, sores

• Skin tears.

• Burn.

• Surgical incisions, pin sites, wounds with staples or sutures.

• Central lines, PICC lines.

• Portacath, mediport, implanted infusion devices, venous access devices.

• Current surgical wound or healed scar of pacemaker insertion.

Excludes:

• Lesions ending in "ostomy" such as suprapubic catheter site (cystostomy), PEG site(gastrostomy), new colostomy, etc.
• Peripheral IV sites.
http://www.nahc.org/NAHC/LegReg/3MNOIP.pdf




GET EVERY POINT YOU CAN!!!!!!!!

[PattiRN]

Thanks...we use Beacon Health also but our Adverse Outcome reports continue to show we have higher than the national level of wounds. We were wondering if MO440 was the reason. Traveler -- the HHRG is higher related to burns and trauma.

[KLQ727]

Yes, that's true. There must be a diagnosis of trauma/burn to get the HHRG points.

However, one point that many nurses forget is that on M0450... once a decub always a decub (unless grafted) and unless it's an open or troublesome decub they don't say yes. Say, for instance, you had a patient on for decub care in January and now again in July they have new ones.... don't forget to count the old ones in the numbers of decubs especially if they were/are stage III or IV. And be sure to carry these same numbers through on all of your OASIS documents for that admission.... our staff tend to let them drop off at recert time.

[Joella]

Hi All,
There is a new CMS posting regarding StageI and StageII decubitus for OASIS
assessment.
Link:
http://www.cms.hhs.gov/oasis/npuap.pdf

[nancynurz]

These are 2 questions that are marked for any and EVERY client in home care! If I have a freckle, a bruise, a bug bite (for crying out loud!), I have a "lesion". Don't forget "scales"-- incredibly dry skin counts too! Clients who need someone to supervise their medications have "memory deficits" and impaired decision making would be the fact that that I don't eat healthy or exercise enough, plus smoking, ingestion of junk food, sleeping less hours than I should for adequate rest . . . I've yet to meet one person who doesn't hit these criteria. I wonder if my regular threats to ground my kids from TV for the rest of their natural lives counts as "verbal disruption" (or at least yelling in my car at the driver in front of me who insits on going 40 mph on the freeway when I'm late to a meeting ).

Finally, there is MO280. I admit a 70 yo s/p hip replacement with COPD and DMI, neuropathy & a hx of DVT . . . ummm, no, I wouldn't be shocked if they passed away within 6 months. As long as the physician hasn't documented a "good" prognosis, I can mark this "less than 6 months" and prevent an adverse event report in OBQM. Again, how many of our clients DON'T have multiple health issues and behaviors that lead to premature death?

Gotta wonder what sadistic person came up with these questions-- "Let's see if they can get this one right " I won't even start on the coding issues; I'm plowing through a hospital COC that has diagnoses differing from the SNF, and neither match what the family was told by the PCP (who happens to be the attending at the SNF by the way!) . . .

[renerian]

Great post.......MO440 seems to be very hard to get staff to understand.....

renerian