Medial Form Sample by xgi19712

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									                 These entries are self-explanatory.




                                                                                             Enter "Date of       Enter "Stage"          Calculates
                                                                                                Wound         information by code           as it
  This date is automatically                                                                                                                                             Enter "Change          (FREE TEXT FIELD)
                                             This date range                                    Onset".        above. Enter each         relates to
stamped whenever you open                                                                                                                                                Code" for each         Use this area for any
                                           MUST indicate the       (FREE TEXT FIELD)                             listed wound in          "Onset"
the file. However, it is set to                                                                                                                                        week as the month        pertinent information
                                          current month being      Use this area to detail                    EITHER of these two          date.
     never go beyond the                                                                                                                                               progresses. Start        you may want to list.
                                           tracked in this file.      things like "left",                      columns... but NOT
 "Through" date indicated in                                                                                                                          Calculates as   with Wk 1 if resident      This cell will "wrap"
                                         This range is used to       "right".. any other                              BOTH.
  the date range for the file.                                                                                                       Enter "Date      soon as "Date   is carried over from      and increase the row
                                         automatically capture      detailed information
The "Age of Wound" will also                                                                                                           Wound             Wound        previous month... or      height automatically.
                                         "new" wounds for the       that you would feel
 stop with the end of month                                                                                                         Healed" when        Healed" is     start with whatever
                                             current month.              valuable for
         being tracked.                                                                                                              applicable.         entered.      week corresponds
                                                                          "location".                                                                                 with week of "onset"
                                                                                                                                                                          if "new" in the
                                                                                                                                                                         current month.
                                                                                                                                                                      (Additional option to
                                                                                                                                                                       enter PUSH Score
 Whatever you name your file each month will                        This file is used to list each pressure wound separately. A resident                                 weekly for each
appear as a "header" on every page of the file                     with multiple wounds will be listed multiple times on the data sheet...                                Stage 3 or 4.)
                                                                                                                                                                                               Enter(or update)
(Data Sheet, Summary, all Graphs). Suggected                                       one row for each active pressure wound.                                                                     current stage of
   naming format... "Facility Name" space                          This file requires some very "basic" knowledge of Excel... knowledge                                                             wound
      ""Month and Year being tracked".                                         you can easily gain by working with the file itself.                                                           per RAI Manual for
         i.e. "ABC Facility May 2009"                                                                                                                                                           MDS Coding.
                                                                      All of the graphs and the Summary Data Sheet are automtically                                                            This coding also
                                                                    calculated and displayed as data is entered on the "PU Data Sheet".                                                       helps to tell a story
                                                                                    For additional information, refer to the                                                                      as current
                                                                            "Guide to the Monthly Pressure Ulcer Tracking Form"                                                                  appearance
                                                                                                                                                                                                 compares to
                                                                                     (a seperate PDF file that is available).                                                                   original stage.
STAGING INFORMATION


The National Pressure Ulcer Advisory Panel has redefined the definition of a pressure ulcer and the stages of pressure ulcers, including the original 4 stages and adding 2 stages on deep tissue
injury and unstageable pressure ulcers.
Pressure Ulcer Definition- A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combintaion with shear
and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated. (Source- NPUAP 10th National Biennial
Conference / February 2007, www.npuap.org)


Stage 1


Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.
Further description: The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage 1 may be difficult to detect in individuals with dark skin tones. May indicate "at risk" persons (a
heralding sign of risk)



Stage 2



Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. Also may present as an intact or open/ruptured serum-filled blister.
Further description: Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
* Bruising indicates suspected deep tissue injury.



Stage 3

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and
tunneling.
Further description: The depth of a Stage 3 pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and Stage 3 ulcers may be shallow.
In contract, areas of significant adiposity can develop extremely deep Stage 3 pressure ulcers. Bone/tendon is not visible or directly palpable.

Stage 4


Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.
Further description: The depth of a Stage 4 pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow.
Stage 4 ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable.


Unstageable

Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, grey, green or brown) and/or eschar (tan, brown or black) in the wound bed.
Further description: Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or
fluctuance) eschar on the heels serves as "the body's natural (biological) cover" and should not be removed.

Suspected Deep Tissue Injury (DTI)


Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying sift tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy,
boggy, warmer or cooler as compared to adjacent tissue.
Further description: Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered
by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.




FOR MDS PURPOSES ONLY- "If eschar and necrotic tissue are covering and preventing adequate staging of a pressure ulcer, the RAI User’s Manual Version 2 instructs the assessor to code the
pressure ulcer as a Stage IV. These instructions must be followed for MDS coding purposes until they are revised. Although the AHCPR and NPUAP system for staging pressure ulcers indicates that
the presence of eschar precludes accurate staging of the ulcer, the facility must use the RAI directions in order to code the MDS, but not necessarily to render treatment." (Source- Guidance to
Surveyors for Long Term Care Facilities, Appendix PP/483.25(c) Pressure Sores/Tag F-314, effective date: November 12, 2004)
         16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls


                                                                                                                                                                                                                           Enter "Change" Code
                                                                                                                                                                                                                              for each week
                         MONTHLY                                                                                    Enter "Stage" (1,2,3 or
                                                                                                                                                                                                                          N= New I= Improved
                                                                                                                     4), "U" (Unstageable)                                    Enter
                     PRESSURE ULCER                               Enter # Code
                                                                                                                    or "DT" (Deep Tissue)                                      "X"
                                                                                                                                                                                                                         S= Same W= Worsened
                                                                                                                                                                                                                                H= Healed
                      TRACKING FORM                                                                                  in appropriate column
                                                                                                                                                                                                                             For Stage 3&4-
                                                                                                                                                                                                                          Option of PUSH Score

                                                              PU Site*




                                                                                                                                                                              Discharge or Death during Current Month
                                                              1=Heel                                                                                       Age of
                                                              2=Foot                                   Date of
                                                                                                                                              Date Wound   Wound    Days to
                                                              3=Buttocks            Location Detail    Wound
                                                                                                                                                Healed       in      Heal
                                                              4=Sacrum                                  Onset
                                                                                                                                                            Days




                                                                                                                                                                                                                                                   Current MDS Stage
                                                              5=Elbow
                                                                                                                                PUs Prior                                                                                                                              Additional
                                        Date of               6=Thigh                                                 PUs
Location /      Resident Last Name,                                                                                             to Admit/                                                                                                                              Comments
                                      Admit or Re- Room # Bed 7=Hip                                                Acquired In-                                                                                         Wk 1 Wk 2 Wk 3 Wk 4 Wk 5
   Unit              First Name                                                                                                 Re-Admit
                                         Admit                8=Coccyx                                               House
                                                                                                                                  (PTA)
                                                              9=Back
                                                              10=Ear
                                                              11=Ischium
                                                              12=Ankle
                                                              13=Knee
                                                              14=Other
A            HALL, DALE               03/02/09   300     B             8                              03/02/09                        3                     29                           x                               N    S    S    I    S         3
A            JAKES, RHEA              03/02/09   200     A            10         RIGHT                03/02/09                        2                     29                                                           N    S    I    I    H
A            JONES, WILLIAM           02/05/09   110     B             1         LEFT                 02/05/09                        3                     54                                                           S    I    S    I    I         2
A            SMITH, JOHN              01/25/09   201     A             3         RIGHT                02/12/09             2                  03/14/09                30                                                 I    H
             WEATHERSFIELD,
A                                     02/22/09 109       A             1         RIGHT                02/22/09                        3                     37                                                           S    S    I    I    S         2
             BEATRICE
B            ARTHER, BEATRICE         03/10/09   111     A             1         RIGHT                03/11/09             1                  03/16/09                 5                                                      N    H
B            DOLAN, MARY              08/25/06   115     A             5         RIGHT                02/12/09             2                  03/09/09                25                                                 I    H
B            DOULEY, CAROLE           02/21/09   214     B             3         RIGHT                03/05/09             1                  03/08/09                 3                                                 N    H
B            GIGUERE, PAUL            10/01/06   219     A             9         LATERAL BACK         02/25/09             2                  03/18/09                21                                                 S    I    H
B            GOODROW, ETHEL           02/17/09   110     A             1         LEFT HEEL            02/17/09                        2       03/15/09                26                 x                               I    I    H
                                                                                 RIGHT UPPER
B            JOBES, MATTHEW           01/06/09 205       B             3         BUTTOCKS             02/03/09             U                                56                                                           S    S    I    I    S         2
                                                                                 LATERAL
B            JOHNSON, BETSY           10/12/06 113       A             1         LEFT HEEL            10/12/06                        3                     901                          x                               S   S     I    S    S         2
B            JONES, OSCAR             01/07/09 201       A             7         LEFT                 01/07/09                        3                     83                                                           S   W                         3
                                                                                 MULTIPLE AREAS
B            MATHIS, ROBERT           12/05/06 217       B             3         AROUNDLEFT AND       02/23/09             2                  03/07/09                12                                                 I    H
                                                                                 RIGHT BUTTOCKS
B            PALTINE, MARY            02/05/09 221       B             2         RIGHT                02/20/09             2                  03/16/09                24                                                 I    I   H
B            PHELPS, WANDA            02/01/09 202       A             4                              02/01/09                        3                     58                                                           S    S   W                    3
                                                                                 LEFT BUTTOCKS
B            RUGBE, NATHAN            03/02/09 217       B             3                              03/02/09                        3                     29                                                           N    S    S    I    S         3
                                                                                 CLEFT
B            WASHBURN, GEORGE         12/15/06 103       B             3         RIGHT                12/15/06                        4                     837                                                          S    I    I    S    S         3

                                                                                 RIGHT POSTERIOR
B            WRIGHT, MARY             01/04/09 217       B             6                              03/05/09             1                  03/09/09                 4                 x                               N    H
                                                                                 THIGH
C            AVERY, PHILLIP           02/09/09 109       B             3         RIGHT BUTTOCKS       02/09/09                        2                     50                           x                               S    S   W     S    S         3
         PU Data Sheet                                                                                           3 of 18
           16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls


                                                                                                                                                                                                                                                            Enter "Change" Code
                                                                                                                                                                                                                                                               for each week
                           MONTHLY                                                                                                            Enter "Stage" (1,2,3 or
                                                                                                                                                                                                                                                           N= New I= Improved
                                                                                                                                               4), "U" (Unstageable)                                          Enter
                       PRESSURE ULCER                                           Enter # Code
                                                                                                                                              or "DT" (Deep Tissue)                                            "X"
                                                                                                                                                                                                                                                          S= Same W= Worsened
                                                                                                                                                                                                                                                                 H= Healed
                        TRACKING FORM                                                                                                          in appropriate column
                                                                                                                                                                                                                                                              For Stage 3&4-
                                                                                                                                                                                                                                                           Option of PUSH Score

                                                                     PU Site*




                                                                                                                                                                                                               Discharge or Death during Current Month
                                                                     1=Heel                                                                                                            Age of
                                                                     2=Foot                                                      Date of
                                                                                                                                                                        Date Wound     Wound       Days to
                                                                     3=Buttocks                         Location Detail          Wound
                                                                                                                                                                          Healed         in         Heal
                                                                     4=Sacrum                                                     Onset
                                                                                                                                                                                        Days




                                                                                                                                                                                                                                                                                    Current MDS Stage
                                                                     5=Elbow
                                                                                                                                                          PUs Prior                                                                                                                                     Additional
                                               Date of               6=Thigh                                                                    PUs
Location /       Resident Last Name,                                                                                                                      to Admit/                                                                                                                                     Comments
                                             Admit or Re- Room # Bed 7=Hip                                                                   Acquired In-                                                                                                Wk 1 Wk 2 Wk 3 Wk 4 Wk 5
   Unit               First Name                                                                                                                          Re-Admit
                                                Admit                8=Coccyx                                                                  House
                                                                                                                                                            (PTA)
                                                                     9=Back
                                                                     10=Ear
                                                                     11=Ischium
                                                                     12=Ankle
                                                                     13=Knee
                                                                     14=Other
C            CASPER, MARY                     02/26/09      200      B               11            RIGHT                        03/10/09             2                                   21                               x                                    N    S    I    I         1
C            DASHNAW, PHILLIP                 12/01/06      119      A                1            RIGHT HEEL                   12/01/06                        4                        851                                                              S    I    I    S    S         2
C            DEGER, WILLIAM                   12/05/06      217      B                3            RIGHT BUTTOCKS               02/25/09             2                  03/08/09                     11                                                   S    H
C            GOLAND, FELIX                    01/21/09      211      B                3            LEFT                         01/21/09                        4                        69                                                               S    S    I    I    I         3
C            HALL, NATHANIAL                  10/21/06      113      C                7            RIGHT HIP                    10/21/06                        4                        892                                                              S    S    I    I    S         3
C            HARRISON, JAMES                  06/21/06      219      A                9            MEDIAL BACK                  09/30/06             3                                   913                                                              W    S                        3
C            JACOBS, JULIE                    03/12/09      111      B                1            RIGHT                        03/12/09                        3                        19                               x                                    N    S   S    I          3
C            JONES, ERIC                      01/05/09      119      A                3            RIGHT BUTTOCKS               01/05/09                        3                        85                               x                               I    S    S   I    S          2
C            MALONE, JOSEPH                   02/22/09      219      B                4                                         03/06/09          2                                      25                                                               N    I    S   W    W          3
C            MOONEY, BERTHA                   06/29/06      201      B                1            RIGHT                        02/04/09         DT                                      55                                                               W    I    S   I    I          3
C            PARKS, JOHN                      11/02/06      217      B                1            LEFT HEEL                    02/28/09          1                     03/02/09                      2                                                   H
C            PERTIER, ROBERT                  03/09/09      122      A                3            LEFT                         03/12/09          2                                      19                                                                    N    S    S    I         1
C            SIKES, WANDA                     02/22/09      205      B                8            COCCYX                       03/15/09          2                     03/30/09                     15                                                             N    I    H
C            WASHINGTON, HELEN                01/21/09 227           B               10            LEFT UPPER                   01/21/09                        3                        69                                                               S    S   W                    3
C            WHITE, MARY                      01/14/09      105      B                8                                         03/01/09             2                  03/08/09                      7                                                   N    H
C            WILL, STELLA                     10/21/06      119      A                3            LEFT BUTTOCKS                10/21/06                        3                        892                                                              S    S    I    S    I         2
D            CAMPBELL, EDWIN                  07/29/06      113      A                3            RIGHT BUTTOCKS               02/12/09             2                  03/04/09                     20                                                   H
D            CANALIS, WILLIAM                 10/15/06      100      A                5            RIGHT ELBOW                  10/15/06                        4                        898                                                              S    S    I    S    I         2
D            FEELEY, IAN                      01/07/09      300      A                7            LEFT                         01/07/09                        3       03/25/09                     77                                                   S    I    I    H
D            SPARKS, JULIA                    03/10/09      218      A                4                                         03/10/09                        1       03/12/09                      2                                                        N    H

                                                                                                                                                                             Average
As of-                              TOTALS--->                                       40                                                              19        21                                    18                  8
                                                                                                                                                                          Days to Heal--->
03/31/09       Reported from-->                       03/01/09                             Through---->                               03/31/09
This material was developed and prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not
necessarily reflect CMS policy. ID number: 8SOW-NY-TSK1A-06-01 (version 3.0- May 2009)




           PU Data Sheet                                                                                                                   4 of 18
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls

                                                                                                                                                                                 THE INFORMATION IN THIS TABLE INCLUDES ONLY THE NEW
             THE INFORMATION IN THIS TABLE INCLUDES ALL PRESSURE ULCERS TRACKED DURING THE MONTH.                                                                                     PRESSURE ULCERS TRACKED DURING THE MONTH.
           THIS INFORMATION INCLUDES THE "ACQUIRED IN-HOUSE" (NOSOCOMIAL) AND "PRIOR TO ADMISSION/RE-                                                                              THIS INFORMATION INCLUDES THE "ACQUIRED IN-HOUSE"
        ADMISSION" (PTA) THAT ARE NEW FOR THE CURRENT MONTH AND ANY CARRIED OVER FROM PREVIOUS MONTHS.                                                                            (NOSOCOMIAL) AND "PRIOR TO ADMISSION/RE-ADMISSION"
                                                                                                                                                                                       (PTA) THAT ARE NEW FOR THE CURRENT MONTH.

                                     Pressure Ulcers                 PUs Prior to                  Total Pressure Ulcers           Pressure Ulcers Healed                                           New PUs
                                                                Admission/Re-Admission                                                                                                                         New PTA PUs    Total New PUs
                                    Acquired In-House                                              Tracked During Month            In-House During Month                                            Acquired
                                                                         (PTA)                                                                                                                                  for Current         for
                                                                                                                                                                                                  In-House for
                                                                                                                                                                                                                   Month      Current Month
                                    #           % of Total         #           % of Total             #          % of Total           #           % of Total                                     Current Month
              Stage 1               4             21.05%             1             4.76%              5            12.50%             5            31.25%                           Stage 1             3           1               4
              Stage 2               12            63.16%             3            14.29%             15            37.50%             10           62.50%                           Stage 2             5           1               6
              Stage 3               1             5.26%             12            57.14%             13            32.50%             1             6.25%                           Stage 3             0           3               3
              Stage 4               0             0.00%              5            23.81%              5            12.50%             0             0.00%                           Stage 4             0           0               0
           Unstageable              1             5.26%              0             0.00%              1            2.50%              0             0.00%                        Unstageable            0           0               0
           Deep Tissue              1             5.26%              0             0.00%              1            2.50%              0             0.00%                        Deep Tissue            0           0               0
            TOTALS-->               19           100.00%            21            100.00%            40           100.00%             16           100.00%                        TOTALS-->             8           5              13


                                                                   THIS INFORMATION                THIS INFORMATION                  THIS INFORMATION               THIS INFORMATION
                                 THIS INFORMATION
                                                                   INCLUDES ALL PUs             INCLUDES ALL "PRIOR TO            INCLUDES ALL NEW PUs          INCLUDES ALL NEW "PRIOR                THIS INFORMATION INCLUDES ALL
                              INCLUDES ALL PRESSURE
                                                                  ACQUIRED IN-HOUSE              ADMIT" (PTA) PRESSURE              ACQUIRED IN-HOUSE           TO ADMIT" (PTA) PRESSURE                 HEALED PRESSURE ULCERS
                              ULCERS TRACKED DURING
                                                                 TRACKED DURING THE             ULCERS TRACKED DURING              TRACKED DURING THE            ULCERS TRACKED DURING                  TRACKED DURING THE MONTH.
                                    THE MONTH.
        Pressure Ulcers                                                  MONTH.                       THE MONTH.                           MONTH.                      THE MONTH.
            by Site                                             # of ALL     % of ALL                                   # of NEW      % of NEW
                                # of ALL       % of ALL         Pressure      Pressure    # of ALL PTA % of ALL PTA      Pressure      Pressure    # of NEW PTA  % of NEW      # of HEALED % of HEALED
                                                                                                                                                                                                             Average Days to
                                Pressure       Pressure          Ulcers        Ulcers       Pressure      Pressure        Ulcers        Ulcers        Pressure  PTA Pressure     Pressure       Pressure
                                                                                                                                                                                                               Heal by Site
                              Ulcers by Site Ulcers by Site    Acquired In- Acquired In- Ulcers by Site Ulcers by Site Acquired In- Acquired In- Ulcers by Site Ulcers by Site Ulcers by Site Ulcers by Site
                                                              House by Site House by Site                              House by Site House by Site
               Heel                 9             22.50%             3            15.79%              6            28.57%             1             12.50%             1            20.00%              3         18.75%           11
               Foot                 1              2.50%             1             5.26%              0             0.00%             0              0.00%             0             0.00%              1          6.25%           24
             Buttocks               13            32.50%             7            36.84%              6            28.57%             2             25.00%             1            20.00%              5         31.25%           15
             Sacrum                 3              7.50%             1             5.26%              2             9.52%             1             12.50%             1            20.00%              1          6.25%            2
              Elbow                 2              5.00%             1             5.26%              1             4.76%             0              0.00%             0             0.00%              1          6.25%           25
              Thigh                 1              2.50%             1             5.26%              0             0.00%             1             12.50%             0             0.00%              1          6.25%            4
                Hip                 3              7.50%             0             0.00%              3            14.29%             0              0.00%             0             0.00%              1          6.25%           77
             Coccyx                 3              7.50%             2            10.53%              1             4.76%             2             25.00%             1            20.00%              2         12.50%           11
               Back                 2              5.00%             2            10.53%              0             0.00%             0              0.00%             0             0.00%              1          6.25%           21
                Ear                 2              5.00%             0             0.00%              2             9.52%             0              0.00%             1            20.00%              0          0.00%            0
             Ischium                1              2.50%             1             5.26%              0             0.00%             1             12.50%             0             0.00%              0          0.00%            0
              Ankle                 0              0.00%             0             0.00%              0             0.00%             0              0.00%             0             0.00%              0          0.00%            0
               Knee                 0              0.00%             0             0.00%              0             0.00%             0              0.00%             0             0.00%              0          0.00%            0
              Other                 0              0.00%             0             0.00%              0             0.00%             0              0.00%             0             0.00%              0          0.00%            0
             TOTAL-->               40           100.00%             19           100.00%            21           100.00%             8            100.00%             5            100.00%            16         100.00%


          Weekly Wound
                                   Wk 1            Wk 2            Wk 3            Wk 4             Wk 5
             Status                                                                                                                                  Total Pressure Ulcers Tracked----->                            40
               New                  7               5                1               0               0
            Improved                6               9                11              12              8                                                 Total Pressure Ulcers Healed
                                                                                                                                                                                                                    24
              Same                  16              15               9               8               10                                             and/or Discharged During Month----->
            Worsened                2               1                3               1               1
             Healed                 2               7                5               1               2
             TOTAL                  33              37               29              22              21


       This material was developed and prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of
       the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. ID number: 8SOW-NY-TSK1A-05-01


Data Summary Sheet
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                                                                     # of ALL Pressure Ulcers by Site
                      THIS INFORMATION INCLUDES
                        ALL PRESSURE ULCERS
                      TRACKED DURING THE MONTH.                 13
 Pressure Ulcers by
        Site

                         # of ALL        % of ALL
                      Pressure Ulcers Pressure Ulcers
                          by Site         by Site       9
        Heel                 9             22.50%
        Foot                 1              2.50%
      Buttocks              13             32.50%
      Sacrum                 3              7.50%
       Elbow                 2              5.00%
       Thigh                 1              2.50%
        Hip                  3              7.50%                    3              3     3
      Coccyx                 3              7.50%                        2                     2        2
        Back                 2              5.00%           1                  1                            1
        Ear                  2              5.00%
                                                                                                                0   0   0
      Ischium                1              2.50%
       Ankle                 0              0.00%
       Knee                  0              0.00%
       Other                 0              0.00%
     TOTAL-->               40             100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                      THIS INFORMATION INCLUDES
                                                                # of ALL Pressure Ulcers Acquired In-House by Site
                        ALL PRESSURE ULCERS
                      ACQUIRED IN-HOUSE TRACKED
                          DURING THE MONTH.
 Pressure Ulcers by                                                7
        Site

                         # of ALL        % of ALL
                      Pressure Ulcers Pressure Ulcers
                        Acquired In-    Acquired In-
                       House by Site House by Site

        Heel                 3             15.79%
        Foot                 1              5.26%
      Buttocks               7             36.84%
      Sacrum                 1              5.26%       3
       Elbow                 1              5.26%
       Thigh                 1              5.26%                                             2    2
        Hip                  0              0.00%
      Coccyx                 2             10.53%           1           1     1    1                         1
        Back                 2             10.53%
        Ear                  0              0.00%
                                                                                        0               0            0   0   0
      Ischium                1              5.26%
       Ankle                 0              0.00%
       Knee                  0              0.00%
       Other                 0              0.00%
     TOTAL-->               19             100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                       THIS INFORMATION INCLUDES
                                                                    # of ALL PTA Pressure Ulcers by Site
                       ALL "PRIOR TO ADMIT" (PTA)
                       PRESSURE ULCERS TRACKED
                           DURING THE MONTH.
 Pressure Ulcers by
        Site
                                                        6       6

                       # of ALL PTA    % of ALL PTA
                      Pressure Ulcers Pressure Ulcers
                           by Site        by Site


        Heel                 6             28.57%
        Foot                 0              0.00%
      Buttocks               6             28.57%                                    3
      Sacrum                 2              9.52%
       Elbow                 1              4.76%
       Thigh                 0              0.00%
                                                                     2                                2
        Hip                  3             14.29%
      Coccyx                 1              4.76%                          1               1
        Back                 0              0.00%
        Ear                  2              9.52%
                                                            0                   0               0          0   0   0   0
      Ischium                0              0.00%
       Ankle                 0              0.00%
       Knee                  0              0.00%
       Other                 0              0.00%
     TOTAL-->               21             100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                       THIS INFORMATION INCLUDES ALL
                                                                  # of NEW Pressure Ulcers Acquired In-House by Site
                      NEW PRESSURE ULCERS ACQUIRED
                        IN-HOUSE TRACKED DURING THE
                                   MONTH.
 Pressure Ulcers by
        Site
                                                                    2                           2
                         # of NEW          % of NEW
                      Pressure Ulcers   Pressure Ulcers
                        Acquired In-      Acquired In-
                       House by Site     House by Site

        Heel                 1              12.50%
        Foot                 0               0.00%
      Buttocks               2              25.00%        1              1           1                           1
      Sacrum                 1              12.50%
       Elbow                 0               0.00%
       Thigh                 1              12.50%
        Hip                  0               0.00%
      Coccyx                 2              25.00%
        Back                 0               0.00%
        Ear                  0               0.00%            0                0          0          0     0           0   0   0
      Ischium                1              12.50%
       Ankle                 0               0.00%
       Knee                  0               0.00%
       Other                 0               0.00%
     TOTAL-->                8             100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                      THIS INFORMATION INCLUDES
                                                                    # of NEW PTA Pressure Ulcers by Site
                       ALL NEW "PRIOR TO ADMIT"
                        (PTA) PRESSURE ULCERS
                      TRACKED DURING THE MONTH.
 Pressure Ulcers by
        Site                                            1       1     1                    1         1
                       # of NEW PTA % of NEW PTA
                      Pressure Ulcers Pressure Ulcers
                           by Site        by Site


        Heel                 1             20.00%
        Foot                 0              0.00%
      Buttocks               1             20.00%
      Sacrum                 1             20.00%
       Elbow                 0              0.00%
       Thigh                 0              0.00%
        Hip                  0              0.00%
      Coccyx                 1             20.00%
        Back                 0              0.00%
        Ear                  1             20.00%
                                                            0              0    0    0          0          0   0   0   0
      Ischium                0              0.00%
       Ankle                 0              0.00%
       Knee                  0              0.00%
       Other                 0              0.00%
     TOTAL-->                5             100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                       THIS INFORMATION INCLUDES
                                                                    # of HEALED Pressure Ulcers by Site
                          ALL HEALED PRESSURE
                      ULCERS TRACKED DURING THE
                                 MONTH.
 Pressure Ulcers by
        Site                                                    5
                       # of HEALED     % of HEALED
                      Pressure Ulcers Pressure Ulcers
                          by Site         by Site


        Heel                 3             18.75%
        Foot                 1              6.25%       3
      Buttocks               5             31.25%
      Sacrum                 1              6.25%
       Elbow                 1              6.25%                                         2
       Thigh                 1              6.25%
        Hip                  1              6.25%
      Coccyx                 2             12.50%
                                                            1        1    1    1     1         1
        Back                 1              6.25%
        Ear                  0              0.00%
                                                                                                    0     0   0   0   0
      Ischium                0              0.00%
       Ankle                 0              0.00%
       Knee                  0              0.00%
       Other                 0              0.00%
     TOTAL-->               16             100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                     THIS INFORMATION                           Average Days to Heal by Site
                   INCLUDES ALL HEALED
                     PRESSURE ULCERS
                   TRACKED DURING THE
                           MONTH.
 Pressure Ulcers                                                             77
     by Site


                   Average Days to Heal by
                            Site


       Heel                  11
       Foot                  24
     Buttocks                15
     Sacrum                  2
      Elbow                  25                   24             25
      Thigh                  4                                                          21
       Hip                   77                        15
                                             11                                   11
      Coccyx                 11
       Back                  21                             2           4
                                                                                               0   0   0   0   0
       Ear                   0
     Ischium                 0
      Ankle                  0
       Knee                  0
      Other                  0
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                  THIS INFORMATION
                                                         # of ALL Pressure Ulcers Acquired
                     INCLUDES ALL
                  PRESSURE ULCERS
                                                                 In-House by Stage
                 ACQUIRED IN-HOUSE
  ALL Pressure FOR THE MONTH ("NEW"
      Ulcers      PLUS ANY CARRIED
    Acquired                                           12
                OVER FROM PREVIOUS
     In-House           MONTHS.
   Tracked for
   the Current   # of ALL    % of ALL
       Month     Pressure    Pressure
                  Ulcers      Ulcers
                 Acquired    Acquired
               In-House by In-House by
                   Stage       Stage
     Stage 1          4         21.05%
                                             4
     Stage 2         12         63.16%
     Stage 3          1         5.26%
     Stage 4          0         0.00%                               1                        1            1
   Unstageable        1         5.26%                                           0
   Deep Tissue        1         5.26%
                                           Stage 1   Stage 2     Stage 3     Stage 4    Unstageable   Deep Tissue
     TOTAL-->        19        100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                     THIS INFORMATION
                                                      # of ALL PTA Pressure Ulcers by Stage
                   INCLUDES ALL "PRIOR
   ALL "Prior to   TO ADMIT" PRESSURE
       Admit/         ULCERS FOR THE
     Re-Admit"      MONTH ("NEW" PLUS                             12
       (PTA)        ANY CARRIED OVER
     Pressure         FROM PREVIOUS
       Ulcers             MONTHS.
    Tracked for
                   # of ALL    % of ALL
    the Current
                     PTA         PTA
       Month
                   Pressure    Pressure
                   Ulcers by   Ulcers by
                     Stage       Stage
                                                                               5
      Stage 1          1         4.76%
      Stage 2          3        14.29%
                                                       3
      Stage 3         12        57.14%
      Stage 4          5        23.81%       1
   Unstageable         0         0.00%                                                        0         0
   Deep Tissue         0         0.00%
                                           Stage 1   Stage 2    Stage 3      Stage 4   Unstageable Deep Tissue
     TOTAL-->         21       100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                   THIS INFORMATION
                                                         # of ALL Pressure Ulcers by Stage
                     INCLUDES ALL
                   PRESSURE ULCERS
                   TRACKED FOR THE                     15
  ALL Pressure     MONTH ("NEW" PLUS
      Ulcers       ANY CARRIED OVER                                13
   Tracked for      FROM PREVIOUS
   the Current          MONTHS.
      Month
                  # of ALL    % of ALL
                  Pressure    Pressure
                  Ulcers by   Ulcers by
                    Stage       Stage

     Stage 1          5         12.50%       5                                  5
     Stage 2         15         37.50%
     Stage 3         13         32.50%
     Stage 4          5         12.50%
                                                                                             1           1
   Unstageable        1         2.50%
   Deep Tissue        1         2.50%
                                           Stage 1   Stage 2     Stage 3     Stage 4    Unstageable Deep Tissue
     TOTAL-->        40        100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                                                                  # of New PUs Acquired
                    THIS INFORMATION
                   INCLUDES ALL NEW
                                                                        In-House for
                   PRESSURE ULCERS                                     Current Month
    ALL NEW        ACQUIRED IN-HOUSE
    Pressure        TRACKED FOR THE
     Ulcers               MONTH
                                                          5
   Acquired In-
     House
                    # of New     % of New
    by Stage
                      PUs          PUs
                    Acquired     Acquired
                  In-House for In-House for
                     Current      Current       3
                      Month        Month
     Stage 1           3         37.50%
     Stage 2           5         62.50%
     Stage 3           0          0.00%
     Stage 4           0          0.00%
   Unstageable         0          0.00%                               0           0           0             0
   Deep Tissue         0          0.00%
                                              Stage 1   Stage 2     Stage 3     Stage 4   Unstageable   Deep Tissue
     TOTAL-->          8         100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                                                               # of New PTA PUs for
                    THIS INFORMATION
                   INCLUDES ALL NEW
                                                                   Current Month
                    "PRIOR TO ADMIT"
                   PRESSURE ULCERS
  ALL NEW PTA       TRACKED FOR THE                                3
    Pressure              MONTH
     Ulcers
    by Stage
                  # of New    % of New
                 PTA PUs for PTA PUs for
                   Current     Current
                    Month       Month

     Stage 1          1         20.00%
                                             1         1
     Stage 2          1         20.00%
     Stage 3          3         60.00%
     Stage 4          0         0.00%
   Unstageable        0         0.00%                                          0          0             0
   Deep Tissue        0         0.00%
                                           Stage 1   Stage 2    Stage 3     Stage 4   Unstageable   Deep Tissue
     TOTAL-->         5        100.00%
16a8dbe4-6158-4bde-b01a-ea392035a9a1.xls




                   THIS INFORMATION
                                                      # of HEALED Pressure Ulcers by Stage
                     INCLUDES ALL
                   PRESSURE ULCERS
                    HEALED FOR THE
  ALL Pressure     MONTH ("NEW" PLUS
                   ANY CARRIED OVER                    10
      Ulcers
   HEALED for       FROM PREVIOUS
   the Current          MONTHS.
      Month
                     # of       % of
                  HEALED      HEALED
                  Pressure    Pressure
                  Ulcers by   Ulcers by
                    Stage       Stage        5

     Stage 1          5         31.25%
     Stage 2         10         62.50%
     Stage 3          1         6.25%
     Stage 4          0         0.00%                             1
   Unstageable        0         0.00%                                         0              0         0
   Deep Tissue        0         0.00%
                                           Stage 1   Stage 2    Stage 3     Stage 4   Unstageable Deep Tissue
     TOTAL-->        16        100.00%

								
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