OASIS Complete Webinar Series Mastering the OASIS Skin Assessment Presented By: Rhonda Marie Will, RN, BS, HCS-D, COS-C September 10, 2010 243 King Street, Suite 246 Northampton, MA 01060 413-584-5300 fax: 413-584-0220 e-mail: [email protected]www.fazzi.com
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Mastering the OASIS Skin Assessment · include PPS and OASIS assessment skill building, documentation, intake and referral processes, care management, regulatory compliance, and policy
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OASIS Complete Webinar Series
Mastering the OASIS Skin Assessment
Presented By: Rhonda Marie Will, RN, BS, HCS-D, COS-C
Instructions and Handouts for: Fall Risk Assessment
It is very important that you have these materials printed and ready to use prior to the start of the training. In order to participate in this training you will need to do the following:
1. Dial 1 (877) 615-4339 at least 10 minutes prior to the start of the webinar. 2. When asked, enter Conference ID 8160290#. 3. Give your agency’s name. 4. At this time you will be entered into the call and in “listen mode.” 5. If at any time you need assistance you may press *0 for the operator. 6. There will be a Q & A period toward the end of the session. Questions will be answered in the
order in which they are received. To ask a question, press *1. You will have the opportunity to ask your question and then be returned to “listen mode.” Do not press *1 prior to this time.
7. To view the presentation online you must click on the link sent to you from GoToWebinar. Nurses Only: Directions to receive contact hours for the training.
1. Each participant must complete an evaluation in order to receive contact hours. Click on the following link in order to access the online evaluation form:
https://www.surveymonkey.com/s/LTLPSPR *Please allow four weeks for processing. Rhonda Will, RN, BS, COS-C, HCS-D is a Senior Clinical Consultant and Assistant Director of the Home Care Quality Institute for Fazzi Associates, Inc. She has thirty eight years experience as a registered nurse and has worked in home health care since 1979 in various clinical, administrative and management roles. Rhonda has extensive experience in staff development and as a trainer. Her areas of expertise include PPS and OASIS assessment skill building, documentation, intake and referral processes, care management, regulatory compliance, and policy and procedure development. With Fazzi Associates Rhonda has developed and provides OASIS clinical training, audit and management training programs and basic ICD-9-CM Coding training. She oversees the team of professional associates who also provides clinical record audits and on site trainings. She presents OASIS and basic coding training on site and by audio conferencing for home health agencies, state home health associations and national professional and commercial organizations. Rhonda provided clinical leadership for the 2003 3M National OASIS Integrity Project. She has developed a reputation in the home health industry as an OASIS Expert and is often interviewed for home health care publications. Rhonda currently serves as a member of the Editorial Board for “Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional.”
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Localized injury to the skin and/or underlyingLocalized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.
– Heals by epithelialization• Regeneration of epidermis across a wound surface
– Includes Stage I and II pressure ulcers
Fazzi Associates, Inc. 3
Wound Primer: DefinitionPressure Ulcers
Full thickness tissue lossPenetrates thro gh the fat (s bc taneo s tiss e)– Penetrates through the fat (subcutaneous tissue) and may involve muscle, tendon, or bone
– Deep crater; may tunnel– Heals by granulation, contraction
– Never considered fully healed– Closed when fully granulated and covered with
new epithelial tissue– Includes Stage III and IV pressure ulcers
Suspected Deep Tissue Injury (SDTI)
– Purple or maroon localized area of discolored intact skin OR a blood filled blister due to damage of underlying soft tissue from pressure and/or shear
Stage II pressure ulcers and stasis ulcers thatStage II pressure ulcers and stasis ulcers that close/heal/fully epithelialize are not reportable on OASIS and will not be “newly epithelialized” for data collection.
Stage II pressure ulcers do not granulate and can l b “ t h li ” f d t ll ti
Patient 5 at Discharge, the Stage II PU that was open at SOC has healed. A different Stage II PU is open in another location. The Stage III PU remains unhealed and the other Stage III PU remains closed.
Patient 6 at recert, the Stage II PU that was open at SOC has fully reepithelialized. Another Stage II PU is open in a different location. The Stage III PU now has bone exposed and the other Stage III PU remains closed.
Patient 7 at SOC has 1 PU on the left heel covered with eschar and 1 blood filled blister on the right heel from pressure after many days of bed rest. There is a Stage III PU which closed in the hospital and remains closed.
Patient 7 at recert the 1 PU on the left heel remains covered with eschar. The blood filled blister on the right heel has broken open and is now a Stage III PU. The Stage III PU which closed in the hospital remains closed now.
Patient 8 is bedbound. At SOC there is a skin graft on a Stage III PU with orders not to remove the pressure dressing until the physician's visit. There is a deep red, warm and boggy area noted on the right heel.
Patient 8 at discharge the graft site has healed with some contracture and discoloration of the graft site and the deep red, warm and boggy area noted on the right heel is resolved.
M1324 Stage Most Problematic (Observable) Pressure Ulcer SOC/ROC/FU/DC
Upon inspection, the patient has one PU on the left heel that is covered with eschar. There is one Stage 3 PU on his sacrum. Granulation tissue is present in the wound bed with areas of slough scattered over 10% of the wound bed.
Unhealed: Stage 1 open Stage II open or closed stage III
M1332 Current Number of (Observable) Stasis Ulcers
Upon skin inspection, the patient has one stasis ulcer under an Unna Boot by physician and patient report with physician orders not to change the dressing for 4 days. The other leg has a stasis ulcer with beefy red granulation tissue filling 75% of the wound bed.
Frequently heal by Primary Intention– Wound edges are directly next to one anotherg y– Little tissue loss, no granulation occurs– Wound closure is performed with sutures, staples, or
adhesive
May heal by Secondary Intention– Wound is allowed to granulate
Ostomies even with drains (e.g. thoracostomy/chest tube, etc.)
Cardiac catheterization and/or stent placement via a puncture with a needle
Needle aspiration without drain placement
Enterocutaneous fistula
Retention suture with a button
M1340 Have a Surgical Wound?The patient has a surgical wound with a dressing and an order not to change it until after the doctor’s appointment in 3 days. There is one other healing surgical wound from a drain that was removed and described as well approximated with some serous crusting.
Report surgical wounds that are unhealed and have not become a scar
M1342 Status of Most Problematic (Observable) Surgical Wound
The patient had a hip replacement 4 weeks ago. One week ago the therapist noted that the surgical wound completely re-epithelialized without S/S of a complication. On this DC visit, the wound is described as well approximated, completely re-epithelialized with no scabbing or S/S of infection.