CSM guidelines for Pressure Ulcers

I am sending my wound nurse to a wound reg related seminar. Our documentation is pretty good though. I think the emphasis on individualized interventions that EVERYONE knows about will require some work for us, though.

Yikes...another "new" guideline....another item the state can tag us on. How are all y'all dealing with the new CSM guidelines on Pressure Ulcers? I am the wound committee and my corporation just rolled out a huge new policy on pressure ulcers. I am not really sure how in the world we will get the documentation done. I am everso thrilled that my facility has a VERY low incidence of acquired pressure sores, but the new regs seem unbelievably tedious and time consuming.

Just wondering, have you changed your wound documentation. Presently, we have weekly wound rounds. However, the staff are "supposed" to be documenting on wounds when any changes occur, which does not happen. I am also looking into doing an assessment monthly or bi weekly on resdients that are high risk. Any suggestions would be greatly appreciated. Tracy

I think the regs call for a weekly skin assessment x4 (?) on new admissions. We do a skin assessment weekly on all residents on their bath day and I think that is effective.

We were already doing a "skin check" on bath day. Now we are doing a more thorough assessment...the Norton Plus on admission and for 4 weeks after that. We were supposed to be doing a thorough weekly doc. on any pressure ulcers, but the nurses were slacking off on that, so now it's my job to measure and document on any pressure area weekly. The floor nurses are still responsible for daily documentation and weekly on any non-pressure area. Wound/skin rounds took almost 2 hours this week, and we only have a few people with pressure ulcers, none acquired in our facility, but the ones we got from the hospital are so extensive, it takes forever to measure and document.

As an aside, the corporate chief medical officer sends us a newsletter each quarter. On the front page of the one we just got, he talked about Christopher Reeve....53 years old, round the clock private duty nurses and aides. He died from complications of a pressure ulcer, and his family praised the nurses highly. We, on the other hand, he said, have a 94 year old woman with multisystem failure, she gets a stage one or two, and we are cited for it.

YES! I want so much to point that out to the state surveyors!:angryfire

We have a wound nurse who works three days a week and does all the documentation on all wounds and surgical sites. She does the careplanning on wounds as well, weekly rounds and reports. She has beena godsend and well worth the money!:)

can you explain the new guidlines for me?

seriously, I got this huge packet in my box from the administrator and I was like OMG!

what is it that nurses on the floor should be doing differently? we have 2 of the greatest wound care nurses and they do all their documentation on the wounds but i dont think they do weekly assessments....do we need to start?

It would be better if you read the huge packet of information. Basically we now can get cited for 1. Not preventing skin breakdown, and 2. Not healing it.

I went on the CMS website and purused their "Guidelines to Surveyors". It tells surveyors exactly what to look for and how to investigate all areas, but I paid attention to the pressure ulcer stuff.

It would be better if you read the huge packet of information. Basically we now can get cited for 1. Not preventing skin breakdown, and 2. Not healing it.

well sure it would be better if I read it...but have you seen how much into that is??? :rotfl:

The part about pressure ulcers in the guidelines for surveyors is only a few pages long.... kind of what exactly they will look for and cite! If we aren't prepared, we will be in trouble. :angryfire It's worth looking in to!:)

It really isn't that you have to prevent the sore.. If a resident is at risk for a pressure ulcer, the facility must have a plan of care in place TO TRY and prevent the sore from occurring. This is where a great Care plan coor. would come in handy. If the facility has put interventions into place and the resident still develops the wound despite the facilities best efforts, then the sore must be tracked, the MD must be notified of healing/non healing, treatments that aren't working must be changed, etc. Hope this helps. I did read the big packet..haha If the facility fails to to do any of this, they could potentially be looking at a harm level citation.

It would be better if you read the huge packet of information. Basically we now can get cited for 1. Not preventing skin breakdown, and 2. Not healing it.

It really isn't that you have to prevent the sore.. If a resident is at risk for a pressure ulcer, the facility must have a plan of care in place TO TRY and prevent the sore from occurring. This is where a great Care plan coor. would come in handy. If the facility has put interventions into place and the resident still develops the wound despite the facilities best efforts, then the sore must be tracked, the MD must be notified of healing/non healing, treatments that aren't working must be changed, etc. Hope this helps. I did read the big packet..haha If the facility fails to to do any of this, they could potentially be looking at a harm level citation.

oh sure sandra...show me up by reading that big packet

(can you pm me with the highlights? :chuckle )