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Written by: Darlene D'Altorio-Jones (1959-2015) on Thursday, May 24, 2012 Posted in: Inpatient Rehab

If you didn’t get to attend this highly educational conference in Baltimore, Md., don’t be alarmed as CMS will release a video broadcast that will bring you to the front seat just as though you were there! The materials generated for the conference, along with the excellent selected speakers can help you to adequately educate on the important specifics of both pressure ulcer and CAUTI surveillance required to complete the newest quality indicator reporting. This blog will specifically discuss pressure ulcer reporting and reference materials.

Personally, I had underestimated the learning that needed to occur to appropriately answer the questions for the selected indicators. The IRF-PAI pressure ulcer presentation was a good refresher on the basic concepts associated with pressure ulcer and the distinguishing differences between those and other skin conditions that may be confused with pressure ulcer staging. The speaker, Elizabeth Ayello,PhD, RN, APRN, BC, CWOCN, FAPWCA, FAAN, has an entire career devoted to wound care and a particularly nurturing ability to explain and educate so that staff will be confident in their ability to answer the very simple numbers required for the various stages, and if those have appeared to worsen during a stay or become fully healed. Through this education, the person responsible for entering answers to items 48 A – 50 D on the IRF-PAI will be able to do so confidently.

Of particular education to me was the fact that CMS has adapted the National Pressure Ulcer Advisory Panel’s (NPUAP) 2007 definition for pressure ulcer: ”A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over bony prominence, as a result of pressure or pressure in combination with shear and/or friction.” The classification leads to six categories of which the PAI manual is asking to report only three of the six or stage 2, 3 and 4. “Stage 1”, “unstageable” and ”unstageable suspected deep tissue injury” are the three stages not included for reporting purposes, yet staff must understand the definition of those stages in order to classify 2,3 and 4 correctly.

Resources highlighted within the training materials are available at along with guidelines for treatment and prevention. Of particular interest is the free color staging illustrations that will help staff more easily recognize and stage appropriate to expected reporting CMS guidelines. Take advantage of these help tools so that documentation within the medical record is consistent and supportive of the classifications that appear on the encoded IRF-PAI record.

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