Jeri Lundgren, RN, BSN, PHN, CWS, CWCN, CPT

What are the significant changes from F314 Pressure Sores to F686 Skin Integrity, “Pressure Ulcers,” which takes effect in November?

The first guidance change that will affect your policies is timing of pressure ulcer/pressure injury (PU/PI) risk assessments: performed upon admission, weekly for the first four weeks, then monthly — not quarterly, as F314 mandated — or for any change in condition.

Per the Centers for Medicare & Medicaid Services, while “the requirements do not mandate the use of any specific assessment tool (other than the RAI), many validated instruments are available to aid in assessing the risk for developing PU/PIs.”

Under “Pressure Points and Tissue Tolerance,” CMS added: “The measurement of tissue tolerance can be done in a variety of ways and the method chosen for use in the facility should be identified.” Currently, there is no validated tissue tolerance assessment; CMS neither provides examples nor specifies assessment frequency.

Under “Repositioning,” CMS emphasizes limiting the time individuals spend in a chair without pressure relief, especially those with a current sacrum/coccyx or ischial wound. CMS recommends determining repositioning frequency based on the resident’s “level of activity and mobility, general medical condition, overall treatment objectives, skin condition, and comfort.” I would also add the type of support surfaces being utilized. 

CMS continues: “The efficacy of repositioning must be monitored and revisions to the care plan considered, if the individual is not responding as expected to the repositioning interventions. Ongoing monitoring of the resident’s skin integrity and tissue tolerance is critical to prevent development or deterioration of PU/PIs.”