Posts tagged ‘dyspnea’

January 24, 2011

OASIS Q&As deal with pressure ulcers and surgical wounds

A new set of OASIS Q&As has been posted through the OCCB website.

M1020, M1022, M1024 do not get any mention, but there are several clarifications regarding wounds, and M1012 gets a nod, as well. Below are some highlights, and the link to the full set of Q&As.

M1012
Question 3: For M1012, Inpatient Procedure, can the same relevant procedure be listed twice if the procedure was done on two different dates in the inpatient facility?
Answer 3: Currently, there would be no reason or benefit to listing a procedure more than once.

M1306
Question 8: If you have two Stage IV pressure ulcers with intact skin in-between them and a tunnel that connects them underneath the wound surface, do you have one pressure ulcer or two?
Answer 8: If a patient develops two pressure ulcers that are separated by intact skin but have a tunnel which connects the two, they remain two pressure ulcers.

M1342
Question 9: When sutures are removed from surgical wounds healing by primary intention, how does it affect the healing status of the wound?
Answer 9: For the purposes of scoring the OASIS item, M1342, Status of the Most Problematic (Observable) Surgical Wound, openings in the skin, adjacent to the incision line, caused by the removal of a staple or suture, are not to be considered part of the surgical wound when determining the status of the surgical wound. The status of these sites would be included in the comprehensive assessment clinical documentation.
When determining the healing status of the incision, follow the WOCN Guidance on OASIS-C Integumentary Items, in addition to other relevant current CMS Q&As. The status of “not healing” would only be selected if the wound, excluding the status of the staple/suture site(s), meets the WOCN descriptors.

Other topics in the Q&As:

  • Influenza vaccine
  • M1300, risk of pressure ulcers
  • Explainer of “performing other ADLs” in M1400, dyspnea
  • UTIs
  • Impaired decision-making
  • M1840 and transferring … and lots more.

Looking for the Q&As?

November 18, 2010

Consider a patient’s safety in performing ADL tasks, not just the ability to perform them

I recently heard from an agency with this patient: He has end-stage COPD with dyspnea on almost all ADL’s, even on 3 liters/minute of oxygen.  His O2 saturation remains at 96-98% even when having significant dyspnea, as long as he remains on O2.

He lives with his son and is alone during the day.  He is able to do his own grooming, make his lunch, transfer on-off his toilet  and walk in the home without a device.  He is, however, very S.O.B. doing these things. Breathing, however, is not considered for things like toilet transfer.

Is he scored as being able to do these items independently?

It is important to remember that the ADL questions include the patient’s safety in performing the tasks, not whether he has the ability to perform the tasks. Dyspnea doesn’t necessarily make the patient unable to perform the task safely. On the other hand, if the patient becomes so dyspneic that he collapses, that would indicate he is unsafe. The questions also do not consider efficiency. For example, if he has to take rest breaks during the tasks, those rest breaks do not impact the scoring. The rest breaks actually may increase the safety.

Remember to consider safety as you rate your patients.