No abstract

present at some of the sections that were moved that refer the reader to the Tag to which they belong has been removed, since the language is now at the appropriate Tag. R Appendix PP: Regulatory language revisions made at F150, F156 -483.10(b)(7)(iv), F386, 483.70(a) -untagged, 483.70(a)(4) -untagged. R Appendix PP: Corrections made due to text errors at F333 (Tag was missing), F363 (Tag was missing), F428 (regulatory text missing).III. FUNDING: Medicare contractors shall implement these instructions within their current operating budgets. IV. ATTACHMENTS: Business Requirements x Manual InstructionConfidential Requirements One-Time Notification Recurring Update Notification *Unless otherwise specified, the effective date is the date of service.F153 §483.10(b)(2) --The resident or his or her legal representative has the right--(i) Upon an oral or written request, to access all records pertaining to himself or herself including current clinical records within 24 hours (excluding weekends and holidays); and(ii) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or any portions of them upon request and 2 working days advance notice to the facility. Interpretive Guidelines §483.10(b)(2)An oral request is sufficient to produce the current record for review. Procedures §483.10(b)(3)Look, particularly during observations and record reviews, for on-going efforts on the part of facility staff to keep residents informed. Look for evidence that information is communicated in a manner that is understandable to residents and communicated at times it could be most useful to residents, such as when they are expressing concerns, or raising questions, as well as on an on-going basis. §483.10(d)(2) -The resident has the right to be fully informed in advance about care and treatment and of any changes in that care or treatment that may affect the resident's well-being; Interpretive Guidelines §483.10(d)(2) "Informed in advance" means that the resident receives information necessary to make a health care decision, including information about his/her medical condition and changes in medical condition, about the benefits and reasonable risks of the treatment, and about reasonable available alternatives. ______________________________________________________________________ F155 §483.10(b)(4) --The resident has the right to refuse treatment, to refuse to participate in experimental research, and to formulate an advance directive as specified in paragraph (8) of this section; and Interpretive Guidelines §483.10(b)(4) "Treatment" is defined as care provided for purposes of maintaining/restoring health, improving functional level, or relieving symptoms. The failure to provide notice of room changes could result in an avoidable decline in physical, mental, or psychosocial well-being. ______________________________________________________________________ §483.10(c) Protection of Resident Funds _____________________________________________________________ ...

Long-wave infrared thermography can collect and record objective data, including relative temperature maximums associated with infection, inflammation, and normal healing wounds.

Several pressure ulcer staging systems are frequently cited, but none define pressure-related deep tissue injury under intact skin. The National Pressure Ulcer Advisory Panel recommends using the terms "pressure-related deep tissue injury under intact skin" or "deep tissue injury under intact skin" for describing these lesions and encourages investigators to establish the epidemiology and natural history of these lesions.

A deep-tissue pressure injury (DTPI) is a serious type of pressure injury that begins in tissue over bony prominences and can lead to the development of hospital-acquired pressure injuries (HAPIs). Using a commercially available thermal imaging system, study authors documented a total of 12 thermal anomalies in 9 of 114 patients at the time of admission to one of the study institution’s ICUs over a 2-month period. An intensive, proven wound prevention protocol was immediately implemented for each of these patients. Of these 12 anomalies, 2 ultimately manifested as visually identifiable DTPIs. This represented a 60% reduction in the authors' institution’s historical DTPIs/HAPI rate. Because these DTPIs were documented as present on admission using the thermal imaging tool, researchers avoided a revenue loss associated with nonreimbursed costs of care and also estimated financial benefits associated with litigation expenses known to be generated with HAPIs. Using thermal imaging to document DTPIs when patients present has the potential to significantly reduce expenses associated with pressure injury litigation. The clinical and financial benefits of early documentation of skin surface thermal anomalies in anatomical areas of interest are significant.

Healing times were decreased in those individuals who had lower HgbA1c values. Decreased healing times result in lower cost for the patient, decreased chance of infection due to lack of portal of entry, and increased quality of life. Patient education may increase self-care practices in the diabetic population regarding better glucose control.

Minimal literature exists on skin failure, yet caregivers and the public must be aware of, assess for, and consider this phenomenon in their care. Based on this literature review, skin failure was defined by the authors as an event in which the skin and underlying tissue die due to hypoperfusion that occurs concurrent with severe dysfunction or failure of other organ systems. Skin failure can be categorized as acute, chronic, or end stage. Pressure ulcers, a type of skin death, frequently occur in persons with a heavy disease burden, especially those at or near the end of life, despite good care.

In the vast majority of cases, appropriate identification and mitigation of risk factors can prevent or minimize pressure ulcer (PU) formation. However, some PUs are unavoidable. Based on the importance of this topic and the lack of literature focused on PU unavoidability, the National Pressure Ulcer Advisory Panel hosted a multidisciplinary conference in 2014 to explore the issue of PU unavoidability within an organ system framework, which considered the complexities of nonmodifiable intrinsic and extrinsic risk factors. Prior to the conference, an extensive literature review was conducted to analyze and summarize the state of the science in the area of unavoidable PU development and items were developed. An interactive process was used to gain consensus based on these items among stakeholders of various organizations and audience members. Consensus was reached when 80% agreement was obtained. The group reached consensus that unavoidable PUs do occur. Consensus was also obtained in areas related to cardiopulmonary status, hemodynamic stability, impact of head-of-bed elevation, septic shock, body edema, burns, immobility, medical devices, spinal cord injury, terminal illness, and nutrition.