Whats New? MDS 3.0 Update in Wound Care

March and April, CMS has reconsidered its original guidance regarding how to code blister pressure ulcers on the revised Minimum Data Set (MDS) version 3.0. Previously, CMS directed that any pressure ulcer that presents as a blister regardless of what type of fluid seen (serous, sero-anguineous, or blood filled) was to be coded as a stage 2 . This is no longer true, not all pressure ulcer blisters are coded as stage 2 for MDS 3.0.

This July, CMS posted new information on its website that shifts the coding of pressure ulcer blisters to differentiate between those that are stage 2 (M0300B) from those that are unstageable suspected deep tissue injury (M0300G) based on a more comprehensive assessment of the resident and ulcer site. Visual observation of the type of fluid in the blister is not enough; you must now do a complete staging assessment that includes determining if the tissue adjacent to or surrounding the blister has any signs of tissue injury. These can include skin color changes (darker than surrounding skin), differences in tissue consistency (bogginess or firmness), tenderness, or skin temperature changes (warm or cool). Remember that despite an adequate lighting source, assessment of deep tissue injury may be difficult in residents with darkly pigmented skin.

CMS has stated in the updated RAI manual that “Stage 2 ulcers will generally lack the surrounding characteristics found with a deep tissue injury” while “blood-filled blisters related primarily to pressure are more likely than serous filled blisters to be associated with a suspected deep tissue injury.”  “Do not code M0300G when a lesion related to pressure presents with an intact blister and the surrounding or adjacent soft tissue does not have the characteristics of Deep Tissue Injury.”

While CMS continues to use the adapted NPUAP 2007 pressure ulcer staging definitions in section M for MDS 3.0, this most recent coding change brings long term care staging guidance more closely in alignment with pressure ulcer staging in other care settings.

MDS 3.0 is brand new, and we will continue to have late breaking updates, so please be patient and understand that standards are continuing to evolve.  Continue to visit the official CMS website for any other changes or updates as we countdown the days to the planned MDS 3.0 implementation date of October 1, 2010. 

Our EMR has reflects the assessment and documentation needed for you to complete the MDS 3.0 M section. Our wound specialist and our EMR are the ultimate resource to help you maintain compliance with MDS 3.0 documentation to achieve superior outcomes in wound healing.

Type Of Wounds

When you consider the manner in which the skin or tissue is broken, there are six general kinds of   wounds:   abrasions,   incisions,   lacerations, punctures,   avulsions,   and   amputations.   Many wounds,  of  course,  are  combinations  of  two  or more  of  these  basic  types.

ABRASIONS
 
Abrasions  are  made  when  the skin  is  rubbed  or  scraped  off.  Rope  burns,  floor burns, and skinned knees or elbows are common examples  of  abrasions.  This  kind  of  wound  can become  infected  quite  easily  because  dirt  and germs are usually embedded in the tissues.

INCISIONS.
 
  Incisions,  commonly  called CUTS,  are  wounds  made  by  sharp  cutting  in- struments  such  as  knives,  razors,  and  broken glass. Incisions tend to bleed freely bec ause the blood vessels are cut cleanly and without ragged edges. There is little damage to the surrounding tissues. Of all classes of wounds, incisions are the least likely to become infected, since the free flow of blood washes out many of the microorganisms (germs)  that  cause  infection

LACERATIONS


  These  wounds  are  torn, rather than cut. They have ragged, irregular edges and  masses  of  torn  tissue  underneath.  These wounds are usually made by blunt, rather than sharp,  objects.  A  wound  made  by  a  dull  knife, for instance, is more likely to be a laceration than an incision. Bomb fragments often cause lacera- tion.  Many  of  the  wounds  caused  by  accidents with  machinery  are  lacerations;  they  are  often complicated  by  crushing  of  the  tissues  as  well. Lacerations are frequently contaminated with dirt, grease, or other material that is ground into the tissue;  they  are  therefore  very  likely  to  become infected.  

PUNCTURES
 
Punctures are caused by ob- jects that penetrate into the tissues while leaving a small surface opening. Wounds made by nails, needles, wire, and bullets are usually punctures. As  a  rule,  small  puncture  wounds  do  not  bleed freely;  however,  large  puncture  wounds  may  cause severe internal bleeding. The possibility of infec- tion is great in all puncture wounds, especially if the penetrating object has tetanus bacteria on it. To prevent anaerobic infections, primary closures are  not  made  in  the  case  of  puncture  wounds.

AVULSIONS

  An  avulsion  is  the  tearing away of tissue from a body part. Bleeding is usu- ally heavy. In certain situations, the torn tissue may be surgically reattached. It can be saved for medical  evaluation  by  wrapping  it  in  a  sterile dressing  and  placing  it  in  a  cool  container,  and rushing  it,  along  with  the  victim,  to  a  medical facility.  Do  not  allow  the  avulsed  portion  to  freeze and  do  not  immerse  it  in  water  or  saline.

  AMPUTATIONS
 
A  traumatic  amputation is  the  nonsurgical  removal  of  the  limb  from  the body. Bleeding is heavy and requires a tourniquet, which  will  be  discussed  later,  to  stop  the  flow. Shock is certain to develop in these cases. As with avulsed  tissue,  wrap  the  limb  in  sterile  dressings, place  it  in  a  cool  container,  and  transport  it  to the hospital with the victim. Do not allow the limb to  be  in  direct  contact  with  ice,  and  do  not  im- merse  it  in  water  or  saline.  The  limb  can  often be  successfully  reattached.