I have been on a mission to either get better understanding or change the CMS guidance on OASIS surgical wound score related to venous access devices. With the implementation of OASIS-C, there is better guidance as far as staging surgical wounds. However there is significant confusion on how to score M1340 related to central venous access devices and the WOCN guidance did not cover this issue.
Previous guidance from CMS states that central venous access devices are always considered surgical wounds. I believe the original intent was that the skin break (surgically created) which the access device was placed into the body is actually the surgical wound. CMS has taken the original written guidance to mean that the actual device is the surgical wound. Previous guidance states that when a venous access device such as a mediport is in place, even if not used, it will always be considered a surgical wound. This is confusing the homecare industry.
With the new OASIS guidance which states, "For the purpose of this OASIS item (M1340), a surgical site closed primarily (with sutures, staples or a chemical bonding agent) is generally described in documentation as a surgical wound until re-epithelialization has been present for approximately 30 days, unless it dehisces or presents signs of infection. After 30 days, it is generally described as a scar and should not be included in this item."
Industry consultants and CMS representatives state that venous access devices fall out of this guidance although the official OASIS-C guidance manual does not state this. They say that this is because WOCN stated in the past that a central venous access device is always considered a surgical wound therefore CMS has taken that stance.
There needs to be clarification from the WOCN on how to score venous access devices. Here are my suggestions:
***These guidelines are not approved by CMS or WOCN. These are just my suggestions for what they need to change. ***
First, the term of venous access devices needs to be broken down into two subcategories; implanted venous access devices and other central venous access devices.
Implanted venous access devices (i.e. mediport)
When scoring M1340 such as a mediport, the clinician will assess the surgical implantation site wound. If the wound has been epithelized for greater than 30 days, the clinician will mark No.
If the site is epithelialization is less than 30 days then M1340 would be marked 1 or 2. If 1, then score M1342 accordingly.
Other central venous access devices (i.e. central lines)
As the access device is keeping the original surgical wound open, M1340 would be answered 1 and then M1342 would be marked non-healing. Once the access device is removed, the surgical would then be scored accordingly to the WOCN guidelines. Once the site is epithelized for greater than 30 days, it is no longer considered a surgical wound.
***These guidelines are not approved by CMS or WOCN. These are just my suggestions for what they need to change. ***
These suggestions have been submitted to CMS and the Chairperson from the WOCN OASIS-C Committee. We will see if common sense prevails or not.
