Unavoidable pressure injuries
Could anyone provide any detail or guidance related to development of pressure injuries as the result of patient refusal (with documentation to back this up) to turn or roll Q2 hours? This could also be related to hemodynamic instability and inability to turn patient.
Has your organization taken unnecessary PSI 3 penalties due to this? Did you develop any strategies to mitigate this? Do you code the pressure injury? Etc...
Thanks for any input!
Comments
Our hospital was trying to figure out how to mitigate this as well, but we (CDI) shared the AHRQ Specifications Manual PSI_03_Pressure_Ulcer_Rate.pdf (ahrq.gov). Unfortunately, refusal to be turned is not an exclusion criterion (too easy to overuse to get around the measure). Document and treat the pressure injury appropriately and let the inclusion and exclusion criteria do its work. We suggested to them that an increase in pressure injuries could be a sign of other issues (inadequate initial assessment to discover the pressure injury, staffing, equipment, supplies, etc.).
To the question does our hospital code the pressure injury??... yes, our coders code them. CDI intervened on this request. It should not be a subjective determination to code or not to code. We are reminded by our Medical Records/CDI Director that the record should be complete and tell the clinical truth of the patient.