Pressure Ulcer Vs Kennedy Terminal Ulcers ???
I just received this from our wound care nurse and wanted to see if anyone else has heard of this? Our Quality Director is really excited since she is thinking we will not have HAC's based on this new terminology (which our coders say can't be coded). The associated white paper on care of these ulcers at end of life is included. Suggestions or thoughts welcomed!
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Date:
May 22, 2017 at 4:19:35 PM CDT
To: <HRET-HIIN-HOSPITAL-WIDE-TOPICS@AHALS.AHA.ORG>
Subject: Kennedy Terminal Ulcers
Reply-To: HRET-HIIN-HOSPITAL-WIDE-TOPICS <HRET-HIIN-HOSPITAL-WIDE-TOPICS@AHALS.AHA.ORG>
Skin Changes at Life’s End (SCALE) is a term used to describe wounds that appear at the end of life.
SCALE ulcers develop as skin fails as a part of the dying process. Skin failure can be acute, chronic and occur at the end of life. With multi-organ system failure, the body shunts blood away from the skin and towards the vital organs. Under these conditions the skin does not receive enough nutrients and oxygen, leading to waste build up and eventually tissue death. The skin becomes fragile and is more susceptible to injury from friction, moisture, and shearing forces.
Kennedy Terminal Ulcers (KTU) are a subset of SCALE. KTUs develop and deteriorate rapidly, are usually pear or butterfly shaped, and are located predominately on the coccyx or sacral region. This ulcer is a sign that the skin is starting to fail. In a small study in a 10-bed palliative care unit, the length of time between development of the ulcer and death ranged from two hours to six days.
While most pressure injuries are considered avoidable, KTUs, or acute skin failure, will develop even when evidence based interventions are reliably maintained. Differentiating KTUs from pressure injuries is important because patient centered goals and care planning will be different. The National Pressure Ulcer Advisory Panel (NPUAP) published a white paper on pressure ulcers in individuals receiving palliative care that outlines appropriate injury preventative and management interventions that focus on supporting patients’ comfort, dignity, and personal choices during the end of life period. Priorities for this patient population are not wound healing, but instead are focused on managing pain and odor, honoring patient preferences, and educating patients and families about the unavoidable process of skin failure.
Comments
Off the top of my head, there are a lot of disorders that are not coded since they are considered part of the dying process. This sounds like part of the dying process and would not be coded because of that. Death is the failure of all organ systems, it certainly makes sense that skin would be included!
Interesting question, though. I had never heard of these!
Laura
Mark