Wound Ulcer Staging and New Standards for Documentation

Inservice: September 29th every hour on the hour in McCain B with Rhonda Bossie starting at 0700 with the last session starting at 1600.

Starting October 1st there are new CMS regulations going into effect that will effect repayment on pressure ulcers. The long and short of it is that if a pressure ulcer isn't documented at the time of admission(POA or present on admission) by the provider then payment is not guarenteed for the care of this ulcer. i.e. patient A admitted for CHF and hyperglycemia and has a stage II on his heel if the provider doesn't dictate or document the ulcers presence and the ulcer either gets worse or we have treatments to administer (lets say we order an air mattress) it's won't be reimbursed. Since the doctors rely heavily on our documentation of these items we need to be certain that the admitting provider is aware of these as soon as possible to ensure that money is captured by the coding folks.

Here are the staging guidelines for review.
http://www.medicaledu.com/staging.htm
and let's be measuring these-I have found that the white boards are helpful for communication of this info to any provider (wound/ostomy nurses and MD's) in addition to our coworkers who may be changing the dressing after you.

Rhonda will be reviewing some of this info also but I figured having it here too will be a resource for you also. And some of you have already attended the webcast Sept. 9th. This is not a repeat presentation of that information.

So attend 1 session with Rhonda on September 29th for one hour-it starts at 0700 until 1600-if you aren't working that day you have some latitude on what time to attend and if you are working we will do our best to get everyone there.

Questions and answers from the presentation on Sept. 9th; some of you had some questions and I poised them to Rhonda after the session I attended.

Q: Are the physicians being trained?
A: Yes at their monthly meeting this month.

Q: Can we take pcitures of wounds to document them?
A: Not at this time-there is alot of training necessary for this plus obtaining cameras for each unit and only specific formats are allowed by Medical records.

Q: Are we going to purchase/use the "Solutions Algorithms" mentioned in the webinar?
A: Not at this time but the Wound/Ostomy Affiliate group is working on standardized treatments based on the products we use in the system.

One more time: September 29th for an hour in McCain B-Wound updates with Rhonda Bossie.

Thanks for reading!
Tracy

Back to School time SCIP= Core Measures=Best Practice

Surgical Care Improvement Project

What does this mean to us-well similar to Core Measures it provices a framework of researched best practices only instead of it being about CHF, MI & Pneumonia that Cores target these are specific to pre and post op measures. You may have already seen them as part of ordersets-for instance stopping antibiotics after a set number of doses or VTE prophylaxis/screening. Other measures that we already know work were researched by other studies and are integrated into these measures-like all the respiratory measures SCU staff will recognize as IHI's 100,000 Lives Campaign; having the HOB greater than 30 degrees in a ventilated patient and Ulcer prophylaxis.

Here is a link to all the SCIP measures-and yes this is monitored and reported since repayment is contingent on our completing each step in the process and like Cores if we miss one measure of the whole surgical experience then we fail the whole"bundle" and payment.

http://www.premierinc.com/quality-safety/tools-services/safety/topics/scip/downloads/scip-final-10-14-05.pdf

One to note especially for SCU staff who commonly recover the big bowel cases is #7 :

Colorectal surgery patients with immediate postoperative normothermia.

Translation: We have 15 minutes to get the postop colorectal patients temp above 96.8.

Everyone is working hard to meet this measure, but even I was unaware that this was the standard until we had already missed one-unfortunate since it decreases the patients risk negative post op issues but now that I know I want you all to be in to make our patients safer also.

Please take the time to read through the measures on the link so that you ar aware also and we can all help each other to facilitate giving our patients the best care research says works.

Thanks for all you are doing for Cores-I went to the meeting on Friday and we were 100% for all measures in June-YEAH US!!!

So if we can do it for Cores-SCIP should be a breeze with a little attention to detail.