LHCR / Home Health Newsletters

April 2008

IMPROVEMENT IN STATUS OF SURGICAL WOUNDS

Improvement in Status of Surgical Wounds encompasses OASIS Items M0440 (Does this patient have a Skin Lesion or an Open Wound), M0482 (Does this patient have a Surgical Wound) and M0488 (Status of Most Problematic, Observable, Surgical Wound).  Improvement in this outcome is demonstrated by an increase in the percentage of patients who display improvement in the condition of their surgical wounds.  Of course, higher percentages are better.  A wound is the presence of any wound resulting from a surgical procedure.  Each wound site is a possible entrance for bacteria.  Wound infections and other complications that prevent or slow healing create additional pain and discomfort.  Furthermore, recovery costs increase due to additional supplies and skilled visits.  Appropriate treatment with subsequent wound healing will improve the patient's safety and health. 

Some clarifications that may be helpful include: 

• Skin lesions are any area of pathologically altered tissue (freckles, bruises, scars, abrasions, skin tears, rashes, even PICC lines).

• Wounds are orthopedic pin sites, central lines, surgical incisions, implanted infusion devices (mediport, port-a-cath), venous access devices, peritoneal dialysis/AV sites.

• All “ostomies” (cystostomy, gastrostomy, ileostomy, colostomy, etc.), whether new or long-standing, are not considered lesions/wounds and are excluded from consideration under M0440.

• A muscle flap to surgically replace a pressure ulcer is a surgical wound and no longer a pressure ulcer.  However, debrided pressure ulcers are not surgical wounds.

• Non-observable wounds are only those that are covered by a non-removable dressing or cast.  This may include steri-strips, if visualization is inadequate and there are orders not to remove them.

• Fully granulating - Incision is well approximated, complete epithelialization (sides fuse together, no areas of separation) and no signs/symptoms of infection.

• Early/partial granulating - Incision is well approximated but not completely epithelialized and no signs/symptoms of infection.

• Not healing - Incision is separated (sides of incision have pulled apart in one or more areas), incisional necrosis (slough or eschar present) or signs/symptoms of infection.

Proper and consistent assessment is important in managing your patient’s health status.  We can provide you with the tools to improve performance and increase efficiency while still providing patient centered care.  For additional intervention tools, click here to view RESOURCES and download LHCR developed brochures and posters that may be useful for in-servicing staff on the importance of consistent assessment.