Attention: Section M Skin Conditions Item Set Changes

As seen in Consultant Connection May 2012 Issue
Erin McClure, BSN, RN, WCC; Nurse Consultant, ICP, Inc.

Beginning April 1, 2012, Changes/Updates to MDS 3.0 Section M have been implemented and include:
  • M0700 – Most Severe Tissue Type for Any Pressure Ulcer, adds option '9' – None of the Above
  • M1040 – Other Ulcers, Wounds, and Skin Problems, adds:
  • Option 'H' Moisture Associated Skin Damage (MASD) i.e. incontinence, perspiration, drainage
  • Option 'G' – Skin Tears
Definitions directly from the Resident Assessment Instrument (RAI) Manual include:

M1040G Skin Tear(s):

Skin tears are a result of shearing, friction or trauma to the skin that causes a separation of the skin layers. They can be partial or full thickness. Code all skin tears in this item, even if already coded in Item J1900B. The cause of the injury often is not known. When the cause is known, they are often linked to the following events: Wheelchair injuries, blunt trauma from accidentally bumping into objects, falls, and transfers. Shearing, friction, or blunt trauma causes separation of skin layers. The subsequent wounds are partialor full-thickness, depending on the degree of tissue damage. These wounds can be very painful and lead to complications if not treated promptly. Subtle skin changes associated with aging increase the risk of skin tear development and interfere with the healing of the skin tear. Aging skin undergoes a process in which it experiences dermal and subcutaneous tissue loss, epidermal thinning, and serum composition changes, which cause decreased skin surface moisture. The skin's elasticity and tensile strength decrease as these other changes occur. Dehydration, poor nutrition, cognitive impairment, altered mobility, and decreased sensation can also increase skin tear risk, (Kim LeBlanc & Sharon Baranoski, July 2009).

M1040H Moisture Associated Skin Damage (MASD):

MASD is a result of skin damage caused by moisture rather than pressure. It is caused by sustained exposure to moisture which can be caused, for example, by incontinence, wound exudate and perspiration. MASD is also referred to as incontinence dermatitis.

A further defi nition of MASD is defi ned as being caused by prolonged exposure to various sources of moisture, including urine or stool, perspiration, wound exudate, mucus, saliva, and their contents (Gray, et al., May/June 2011). MASD is characterized by infl ammation of the skin, occurring with or without erosion or secondary cutaneous infection. Multiple conditions may result in MASD; 4 of the most common forms are incontinence-associated dermatitis, intertriginous, (an area where two skin areas may touch and rub together, resulting in breakdown), dermatitis, (infl ammation of the skin), periwound moisture-associated dermatitis, (infl ammation and erosion of the skin adjacent to chronic wounds associated with exposure to exudate or toxins from bacteria in the wound bed), and peristomal moisture-associated dermatitis, (infl ammation and erosion of the skin adjacent to stoma's associated with exposure to exudate or toxins from bacteria in the stomal site). Although evidence is lacking, clinical experience suggests that MASD requires more than moisture alone. Instead, skin damage is attributable to multiple factors, including chemical irritants within the moisture source, its pH, mechanical factors such as friction, and associated microorganisms. Prevention of MASD is Key and clinicians need to be vigilant both in maintaining optimal skin conditions and in diagnosing and treating minor cases of MASD prior to progression and skin breakdown.

In conclusion, the addition of skin tears and MASD to Section M of the MDS 3.0 are new to this section, and taking a proactive / preventative approach to ensure prompt recognition and appropriate management will be your key to success.

Works Cited:
Gray, M., Black, J. M., Baharestani, M. M., Bliss, D. Z., Colwell, J. C., Goldberg, M., et al. (May/June 2011). Moisture-Associated Skin Damage: Overview and Pathophysiology. Journal of Wound, Ostomy & Continence Nursing , 233-241.

Kim LeBlanc, B. R., & Sharon Baranoski, M. R. (July 2009). Prevention and Management of Skin Tears. Advances in Skin and Wound Care , 325- 332.

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