Hospitals discharging patients to nursing homes with pressure ulcers-no documentation

[americanTrain]

What's the deal with hospitals today, do they not get reimbursed for a hospital stay if the patients develops a wound? When I worked in Med surg, all wounds had to be documented on admission and discharge. We are getting admissions from hospitals where every other person admitted has no documentation or the report says skin is clear. Even in the doctors progress notes! I'm talking about stg 3 and 4 wounds, heels, butts and elbows! Any other nursing homes seeing this unfortunate trend?

[americanTrain]

OOPS! They did it again! Arggggg..... I really dislike some hospitals who want to say that LTC causes all the wounds.

[Christy1019, ASN, RN]

In the ER of my facility it was a big thing that if the pt presented to the ER w/any skin breakdown it must be documented on the ER chart prior to any admission or else the insurance wouldn't pay for the wound care treatment because it couldn't be proven that the wound didn't originate during admission aka caused by lack of proper care. So my GUESS is that if you are seeing this often, especially in pts being discharged after long hospital admissions, maybe some shady hospitals that aren't obviously caring enough to treat or prevent these advanced decubs while the pt remains hospitalized, they might not be documenting them at all to avoid the issues w/reimbursement. Sad to think that may be true but its either that or really lazy, half-a**ed assessments or lack of caring and thinking its easier to dump em on the nursing homes and let them deal with it. Sucks to think that might be the cause.

[americanTrain]

Christy, you are exactly right! I just wanted to hear it from another nurse. There is one particular hospital that refers to us, these patients become our residents and we are supposed to fix their mistakes. I figured it was a reimbursment issue, much like if a patient develops a UTI in the hospital stay, Medicare will not reimburse. Must work the same way with wounds, the paperwork and H&P always states that skin is intact. I assess them as soon as they are brought in the door to find stg 4 to the coccyx, or unstagable heels with black eschar covering the entire heel. Frustration!!!!! Our facilty has to fix these wounds and a lot of the time are sent to the WCC where first visit is 1800. - 2000.00 visit. Wow, now we know where the Medicare money is going to.

[CT Pixie, BSN, RN]

This is exactly why a very focused body audit MUST be done upon admission in my facility. I go over my new/readmit residents with a fine tooth comb and document every little lump, bump, bruise, open area, red area...blah blah..you get the point.

If I'm documenting that they came in with this X x X sized open area/red area/stage whatever, there is no way my facility can be the scapegoat. It goes back to the facility that they came to us from.