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LONG TERM CARE ALERT
On November 12, 2004 CMS released Transmittal # 4 “Guidance to Surveyors for Long Term Care Facilities”. This transmittal will dramatically change the way in which skilled nursing facilities care for pressure ulcers.
REVISED GUIDELINES OVERVIEW
- Pressure ulcers can develop within two hours
- Skin assessments on admission and weekly for four weeks
- Avoid cookie cutter plans of care: Facilities will need to concentrate on resident’s risk factors and prevention
- Advance directives will not void care related to pressure ulcers
- Staff training and knowledge of pressure ulcer care will be challenged
Skilled nursing facilities may find themselves subject to more citations and in some circumstances higher severity citations.
POSSIBLE CITATIONS:
LEVEL FOUR: Immediate Jeopardy Resident acquires a stage 4 avoidable pressure ulcer, or a stage 4,which worsens or shows no improvement.
LEVEL THREE: Actual Harm Resident acquires a stage 3 avoidable pressure ulcer or facility fails to Implement a comprehensive care plan for the treatment of pressure ulcers.
LEVEL TWO: Avoidable pressure ulcers, per surveyor; improperly addressing resident’s risk. Residents with pressure ulcers will be cited under F-Tag #314, however, skilled nursing facilities will also need to address non-pressure ulcers or they could be cited under F-Tag #309.
Quality of Care F-Tag #309 has clarified the definitions of arterial, venous, and diabetic ulcers as well as other wounds. Surveyors may now cite skilled nursing facilities for care related to an ulcer not created by pressure under F-Tag #309.
Under regulation 483.25 Quality of Care: each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychological well being, in accordance with the comprehensive assessment, and plan of care.
The intent of 483.25: the facility must ensure that the resident obtains optimal improvement or does not deteriorate within the limits of the resident’s right to refuse treatment, and within the limits of recognized pathology and the normal aging process.
Skilled Nursing Facilities need to make changes now to their prevention and treatment protocols for the care of pressure ulcers and other wounds.
LEEDer Group manufactures a variety of products some designed specifically for the prevention of wound/decubitus ulcer development:
- Multi Podus * Boots / Adult & Pediatric: With KYDEX, Fleece or No-FLeece, Bed or Ambulation
- Multi Use Boots / Night Splints / Adult & Pediatric: “Flex-E-Core Technology makes these boots customizable to the patient:http://leedergroup.com/xcart/home.php?cat=248
(* Multi Podus® is a registered U.S. Trademark of “Restorative CareofAmerica, Inc” and is used herein with permission. No affiliation or endorsement by “RCAI” should be inferred.) podis