What's in a name? ... Adding insult to ulcer

Jacqueline Vance, RNC, CDONA/LTC
Jacqueline Vance, RNC, CDONA/LTC

The U.S. Food and Drug Administration recently approved a name change for an antidepressant, from Brintellix to Trintellix, because the original name was too close to the antiplatelet drug Brilinta.

Is that kind of like saying you have to change one of your children's names because Belinda is too close to Beatrice? Hmmm, maybe they have a point because my kid's names aren't even remotely similar and I often call them by the wrong name — sometimes even the dog's name if I am stressed out. 

But actually, names have the ability to impact us in ways we may not imagine. What strongly comes to mind is the unintended consequences of the updated pressure ulcer staging recently released from the National Pressure Ulcer Advisory Panel (NPUAP), in which they announced a change in the terminology from pressure ulcer to pressure injury.

No big deal, you say? I mean, you say Tomaaato and I say Tomahhto right? Wrong!

First, what is the Webster's dictionary definition of injury? Well, to quote: “Harm or damage: an act or event that causes someone or something to no longer be fully healthy or in good condition; an act that damages or hurts; violation of another's rights for which the law allows an action to recover damages.”  Are you trembling yet or maybe even need a pair of adult briefs? 

Then think about this: What about changing the terminology in all of your forms, policies and procedures, manuals, education, EHRs, etc.? If you are a large corporation, this could cost millions of dollars. But don't panic, because as of today, we get to stick with the term “ulcer. 

Right now I know people are totally confused. So let me try to help straighten this out. I just heard of one facility where a surveyor literally came in and cited the nursing home for not documenting the word “injury.” I would ask: “What does the RAI manual state? Has that changed? Has the MDS 3.0 changed? Has tag F314 changed?” Of course not! And we are charged by the federal government to follow the RAI. So until THEY change the MDS, tag F314 and RAI manual, keep documenting the way you have been. Don't change it.

Still, we will have consequences since hospital systems and wound care centers might document “injury” as well as the two new definitions of “Medical Device Related Pressure Injury” and “Mucosal Membrane Pressure Injury.”  But those still fit within the older staging; we will just need to be very diligent in how we harmonize the staging so that we are essentially stating the same thing.

As an educator, though, I do like the expanded definitions and think they help in documenting the ulcer. You may want to teach your staff on those expansions, as it won't affect your staging and does help in documentation.

Please don't get too bugged out yet on these staging changes. anyway. The rumor mill has it that there was so much controversy around the consensus process at the April meeting in Chicago that there probably will be some tweaking to come.

However, the next time a surveyor walks in your building and wants to add insult to ulcer, er, injury (sorry, couldn't help myself!) just ask her or him to show you the CMS transmittal instructing you to stop following the federal guidance and use the NPUAP staging definitions instead.

Then sit back and relax.

Just keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.

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The Real Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.

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