Mo440

Emmes · Jul 17, 2004

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!! :chuckle

Traveler · Jul 17, 2004

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.

Home Health Columnist / Guide · Jul 17, 2004

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 · Jul 21, 2004

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 · Jul 21, 2004

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 · Aug 29, 2004

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 · Aug 29, 2004

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 :rolleyes: ).

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 " :devil: 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, BSN, RN · Aug 29, 2004

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

renerian