Oasis M1342

KittyLovinRN · May 10, 2014

Our office requests the same documentation for knees/hips/surgical incisions ... EVERYTHING at a SOC is considered non-healing. Why are you uncomfortable with this? It's just baseline documentation. We're given the same rationale...need to see some sort of improvement by the discharge. I really wouldn't fret about it, it's a far cry from "falsifying" any sort of charting about your patient I can assure you.

KittyLovinRN · May 10, 2014

P.S. If it's been 30 days since the actual surgery (i.e. if the patient went to rehab for long period of time after hospital) then we're told to put "New Epith"...I guess a 30 day old incision (WNL) is then considered healed.

Home Health Columnist / Guide · May 11, 2014

Remember: Just because a surgical wound is closed, does not = wound fully healed.

Post surgery wound healing phases + Oasis M1342 answers

1.Inflammatory phase = 2 - Early/partial granulation

begins about 12hrs post surgery and lasts up to 3- 5 days

mast cells degranulate and release inflammatory mediators, neutrofils increase to

create wound incision crust

2. Proliferative phase = 2 - Early/partial granulation

growth new blood vessels and tissue begins starts about day 3 - continues for a week. Phase where most wound

dehisence occurs = 3 - Not healing

3. Maturation = 1 - Fully granulating (edges open, crust present) or

0 - Newly epithelialized

(incision closed and smooth healing ridge, 30 days passed)

2-3 months reddened scar occurs due to collegen formation of skin with full

healing taking 12-18 months for scar to fade.

WOCN Society's Guidance on OASIS-C

WOUND OSTOMY CONTINENCE NURSES SOCIETY
GUIDANCE ON OASIS-C INTEGUMENTARY ITEMS
(M1342) Status of Most Problematic (Observable) Surgical Wound:
0 - Newly epithelialized
1 - Fully granulating
2 - Early/partial granulation
3 - Not healing
NA - No observable surgical wound
Definitions:
0 - Newly epithelialized
o wound bed completely covered with new epithelium
o no exudate
o no avascular tissue (eschar and/or slough)
o no signs or symptoms of infection
1 - Fully granulating
o wound bed filled with granulation tissue to the level of the surrounding skin
o no dead space
o no avascular tissue (eschar and/or slough)
o no signs or symptoms of infection
o wound edges are open
2- Early/partial granulation
o ≥ 25% of the wound bed is covered with granulation tissue
o
o no signs or symptoms of infection
o wound edges open
3 - Not healing
o wound with ≥ 25% avascular tissue (eschar and/or slough) OR
o signs/symptoms of infection OR
o clean but non-granulating wound bed OR
o closed/hyperkeratotic wound edges OR
o persistent failure to improve despite appropriate comprehensive wound management
This guidance applies to surgical wounds closed by either primary intention (i.e. approximated incisions) or secondary intention (i.e. open surgical wounds).

So You Think You Know OASIS? - Fazzi Associates

WOCN Guidance: OASIS Skin and Wound Status M0 Items

OASIS Wound Assessment & Documentation Guidelines

Management of surgical wounds

jhdoublin · May 11, 2014

So all of you mark non healing then?

I guess I just don't like that term, but if its the correct option then I guess that's what it'll be.

Thx

I<3H2O, BSN, RN · May 11, 2014

I am COS-C and a surgical incision can start to re-epithelialize in as little as a few hours up to 3 days. You do NOT mark something just so you can show improvement. If a surgical incision has scabs on it, you have to be able to tell if the scabs are superficial or if they are adhered to the underlying tissue. If adhered to the underlying tissue it is not healing. I do not ALWAYS mark non healing but it is non healing more often then not.

jhdoublin · May 11, 2014

So if u don't mark Non healing then what do u mark? A lot of my incisions are staples and are clean. By the time I see them at home it's on Friday for admission and the surgery was Monday.

Or glued and its hard to tell.

All incisions will show improvement before I dc them, unless they get infected- then I probably wouldn't be dc them anyway. So that's not my issue.

Im studying to get certified soon too and I just wanted the correct answer so I'd know for the test as well as my practice.

Btw- any advice on what to study for the test? I have the 2008 blueprint for oasis accuracy workshop book.

Thx

I<3H2O, BSN, RN · May 11, 2014

For a well approximated surgical incision with staples intact, you have two options: not healing or newly epithelialized. If they have drainage, I would probably mark not healing. Better safe to mark it not healing and have it improve than to mark new epi and have it break open. KWIM? As far as what to study...I took the class and felt very well prepared with the information that was given for the test. Are you planning to take the CBT or pencil and paper?

jhdoublin · May 11, 2014

Yes exactly. I just don't like that word non- healing lol. But that's my hang up I guess.

Computer test. And it's close to $400 out of my pocket. So one time testing is a must.

- I'm going to start another thread about testing- please reply there.

Thx bunch