Open or Closed?

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    Hi. I audit Home Health records for compliance and I have come across something that has stumped me. I need your help please. My understanding of a Stage II decubitus is that the skin is open and it will always have a depth, even if it is superficial. Unless, it is covered with necrotic tissue or has a non-removable dressing. Even if a wound bed has 100% granulation, it would still have depth, right? That is until it has completely re-epithelialized. Am I right about this? If not, I need an explanantion! I want my auditing to be accurate.
  2. 5 Comments so far...

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    Well, to put it not so simply...I have seen Stage I's that leave a small "divot" after resolving and stage IV's that resolve nearly to the normal level of the surrounding tissue. A stage II doesn't extend past the dermis, and the entirety of the dermis/epidermis is extremely thin. I have seen Stage II's resolve and months later leave nothing but a small discolored area of scar tissue. I also see venous stasis ulcers into the subq layer that have a depth of approximately .01cm. Technically, even a person with NO open wounds can have as many "resolved" stage IV, III, or II ulcers as they've ever had. The stage is never downgraded, so technically they can have a stage IV that is .01 in depth that is nearly resolved. The subq tissues will not have regenerated but there will be granulation and epithelial tissue present. So, the long answer is a Stage II can have no depth (< 0.1cm) or it can be resolved (no depth).
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    Good question!! I have usually put "0" on the depth of these ulcers because the depth is so small I cannot really measure it. But I suppose I could estimate that it is 0.01cm...Interesting question.
  5. 0
    Quote from charp101
    hi. i audit home health records for compliance and i have come across something that has stumped me. i need your help please. my understanding of a stage ii decubitus is that the skin is open and it will always have a depth, even if it is superficial. unless, it is covered with necrotic tissue or has a non-removable dressing. even if a wound bed has 100% granulation, it would still have depth, right? that is until it has completely re-epithelialized. am i right about this? if not, i need an explanantion! i want my auditing to be accurate.
    stage ii is partial thickness loss of the dermis, by definition the depth of a stage ii is going to be <2mm, an incriment that small is not going to be able to be reliably and consistantly measured.

    this entity states if the wound is too shallow to measure to document that it's "superficial" http://www.stratishealth.org/documen...guidelines.pdf

    this entity states "[color=#ffffff][color=#ffffff][color=#ffffff]wound depth measurements are not appropriate or needed for partial-thickness wounds" (page 16) http://www.o-wm.com/files/docs/owmsupp_0405.pdf


    by the way, a necrotic would can't be staged, the base of the wound bed has to be exposed before a wound can be staged (an exception to this rule is the mds used in ltc). http://www.npuap.org/pr2.htm
    Last edit by kids on Sep 23, '11
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    Thanks to everyone for the input!
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    WOCN/NPUAP have issued guidelines to be used for home health/OASIS that you should be familiar with. In a nutshell, if you have a stage 2 that is OPEN then it is nonhealing - no matter what the measurements. Once it is healed then it is no longer reportable - because stage 2 are partial thickness, they do not heal by granulation - they epithelialize. Once epithelialized they are closed. They do not cause underlying tissue damage so, in essence, once closed up - they are gone. No reverse staging. Either you have a stage 2 or you don't. This is Medicare OASIS guidelines for home health - not talking about hospital/SNF, etc.


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