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11/7/2017
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We bring advanced wound care, clinical excellence, and servant leadership to you…
Assessing and Correctly
Identifying Wounds
Wound Care Plus, LLC @woundcareplusllc @mywoundcareplus
Statement of Disclosure
• Chief Executive Officer and Founder for Wound Care Plus, LLC
• Educational Speaker and Negative Pressure Wound Therapy Expert
• Editorial Member for Kestrel Wound Source (www.woundsource.com)
• Long Term Care/Long Term Acute Care Advisory Panel (Inception 2012)
• Professionals Dedicated to Quality Wound Care (Inception 2013)
• Invited Expert for the American Medical Directors Association for Pressure Ulcers and Other Wounds
Workgroup Revision to LTC Standards (2014)
• Principal Investigator for Clinical Research Trials Santyl vs. Hydrogel (www.clinicaltrials.gov)
• Principal Investigator for Clinical Research Trials Allevyn Life Non-bordered (www.clinicaltrials.gov)
National Publications
• Clinical Competencies for Long Term Care Collagenase Santyl (2015)
• Quality Assurance and Performance Improvement Clinician’s Resource Guide (2016)
• Transitions of Care Clinician’s Resource Guide (2016)
• Debridement: Clinician’s Resource Guide (2016)
• PICO Single Use NPWT System: Clinical Competency for Long-term Care Providers (2016)
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Source: CMS’s RAI Version
3.0 Manual Page M-1
“It is imperative to determine
the etiology of all wounds
and lesions, as this will
determine and direct the
proper treatment and
management of all wounds”
Source: CMS’s RAI Version 3.0 Manual Pages:
M-9
M-11
M-13
M-16
M-21
2. For the purposes of coding; determine that the lesion being assessed is primarily related to pressure and that other conditions have been ruled out. If pressure is not the primary cause, do not code here.
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Malignant Lesions
Calciphylaxis
Discoid Lupus Skin Lesions
Sarcoidosis Lesions
Surgical Wounds
Venous Insufficiency Ulcers
Arterial Ulcers
Pyoderma Gangrenosum Typical (Classic) Atypical Peristomal Pustular Bullous Vegetative
Majorlin’s Ulcer Acanthosis Nigricans
Digital Sclerosis
Bullosis Diabeticorum
Necrobiosis Lipoidica Diabeticorum
Diabetic Dermopathy
Eruptive Xanthomatosis
Disseminated Granuloma Annulare
Diabetic Ulcer
Trauma
Pemphigoid Bullous Cicatricial Gestationis
Sweet’s Syndrome
Skin Tears
Burns
Vasculitis
Collagen Vascular Diseases
Necrotizing Infection
Pemphigus Radiation Necrosis Ulcer
Neuropathic Ulcer
Source: The Physician’s Guide to The Wound Institute
Page 26: Treatment Algorithm
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Undermining
Tunneling
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Stable Eschar-Do Not Touch • Dry • Firmly Adherent • Eschar Intact • Peri-wound has no erythema,
no fluctuance, no bogginess, no maceration, no warmth, no redness, no induration or swollen tissue
Unstable-Consider having specialist remove • Drainage • Edges peeling or lifting up • Eschar does not cover the entire wound • Peri-wound may have erythema,
fluctuance, bogginess, temperature or color changes, maceration, warmth or redness, induration, or swollen tissue
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Stable Eschar Body’s Perfect Band-Aid
Unstable Eschar Something’s brewing
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Fungating
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Tumor
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Purulent-opaque, milky and sometimes green, yellow or brown
Sanguineous-reddish, thin and watery
Serous-clear, amber, thin and watery
Serosanguineous-clear, pink, thin and watery (blood-tinged)
Commons Types
Drainage Amount None-dry wound bed
Scant-wound is moist. Dressing will have no more than a drop or two of drainage present or dressing may be dry
Small-minimal amount of drainage covering less than 25% of the dressing
Moderate-wound is wet and drainage covers 25-75% of the dressing
Large (Copious)-wound has significant fluid that may fill the wound and drainage will cover more than 75% of the bandage. Peri-wound may shows signs of maceration
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Demarcation/Demarcating
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Epibole or Epiboly
Erythema
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Hemosiderin Staining
Heralding Sign
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Hypergranulation Tissue
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Induration
Maceration
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Rubor
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Laboratory Draws
MRI Scan
CT Scan
X-ray
Venous Ultrasound
Arterial Ultrasound Ankle-Brachial Index
Tissue Cultures
Punch Biopsy
Wedge Biopsy
pH Testing
Debridement
Pressure Mapping Arteriogram
Venogram
Transcutaneous Oxygen Monitoring
Diagnosis of Exclusion
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Questions?
Martha R. Kelso, RN, HBOT, CEO, WCP
(888) 256-3814
Martha R Kelso facebook.com/MarthaRKelso @MarthaRKelso
