Content area
Full text
The RAI User's Manual for MDS 3.0 is organized nicely. Chapter 3 is divided into 20 sections, each of which begins with a title (e.g., Section M: Skin Conditions) and a description of the sections intent. It then proceeds through the section, item by item, giving coding instructions. These start with the Item Rationale, which includes Health-Related Quality of Life and Planning for Care instructions, then move on to Steps for Assessment and Coding Instructions.
Imagine that all you had to guide you in managing pressure ulcers were the Planning for Care instructions of section M. What would you learn? Well, actually, some very important concepts.
SECTION M HIGHLIGHTS
Pressure Ulcer Risk (M0100, M0150. For starters, item MO 100, Determination of Pressure Ulcer Risk, sets as its goal that "the care planning process should include efforts to stabilize, reduce, or remove underlying risk factors" (CMS, 2013, p. M-l).
From this first Planning for Care statement we know that determining "underlying risk factors" is important. It is best made using the quality assurance and performance improvement (QAPI) principle of getting to the root of the problem by conducting a root cause analysis (RCA). According to CMS' QAPI at a Glance guide, "The RCA process leads to digging deeper and deeper-looking for the reasons behind the reasons"(p. 18).
There is a difference between "healed" and "closed." For example, "unstageable pressure ulcers although closed,' (i.e., may be covered with tissue, eschar, slough, etc.) would not be considered 'healed'" (p. M-l). Care planning analysis and interventions should be aggressively pursued when there is damaged tissue, even if the skin is still intact.
Tensile strength is defined as "the greatest longitudinal stress a substance can bear without tearing apart." Care-planning considerations in section M instruct that "tensile strength of the skin overlying a closed pressure ulcer is 80% of normal skin tensile strength" (p. M-l). To protect the skin from re-injury, aggressive preventive measures should be planned and written into the care plan.
After determining pressure ulcer risk, caregivers are instructed to "monitor the impact of the interventions, and to modify the interventions as appropriate" (p. M-3). If interventions aren't working, they must be changed. Every caregiver plays a part in this process.
Unhealed Pressure Ulcers (M0210). When preventive measures...