MDS Alert
What Do You Think?
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Deal With The Downstaging Dilemma Question: How can facilities follow the MDS instructions requiring them to downstage pressure ulcers as they heal, while also meeting the standard of care promoted by the National Pressure Ulcer Advisory Panel, which forbids downstaging?
Answer: (see "Know the MDS Definitions For Staging Wounds"): You can deal with this conflict in a way that promotes MDS coding instructions and the standard of care -- and avoids confusion among staff, says Marilyn Mines, RN, a health care consultant with FR&R Healthcare Consulting in Deerfield, IL.
"The instructions for coding the MDS say you document what you see," says Mines. So if the resident, for example, has a healing stage 4 that meets the criteria for a stage 3, you must code the wound as a stage 3 (see "Know the MDS Definitions For Staging Wounds") But your documentation could then indicate a healing stage 4 ulcer that currently looks, by definition, like a stage 3," Mines suggests. This tack supports how you code the MDS, while continuing to use the NPUAP standards. (The RAI manual says facilities are welcome to use the NPUAP standards for staging wounds but not for coding them on the MDS.)
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