Early Skin Temperature Characteristics of the Kennedy Lesion (Kennedy Terminal Ulcer).

BACKGROUND: Pressure injuries are associated with skin temperature changes, but little is known about skin temperature characteristics of the Kennedy Lesion (KL). PURPOSE: The purpose of this study was to describe early skin temperature changes in KLs using long-wave infrared thermography. METHODS: KLs were identified from chart review in 10 ICU patients. Skin assessments were performed within 24 hours of new skin discoloration. Temperature measurements were performed using a long-wave infrared thermography imaging system. Relative Temperature Differential (RTD) between the discolored area and a selected control point was calculated. RTDs of > +1.2 degrees C and < -1.2 degrees C were considered abnormal. Demographic data and observable characteristics of the KL were collected when available. Descriptive statistics (Mean plus/minus SD; % ) were used. RESULTS: The major finding of this study was that there were no early skin temperature differences between the KLs and surrounding skin. CONCLUSION: The early stage of the KL may be limited to microvascular injury which results in a normal skin temperature. More studies are needed to verify this finding and to ascertain whether KL skin temperature changes over time. The study also supports the bedside use of thermography in skin temperature assessment.

Supervision Requirements: Criteria for the Nurse and Auxiliary Staff When Providing Patient Care Visits.

Physician or advanced care clinicians' (advanced practice nurses, physician assistants) orders are routinely carried out by nursing staff, with the goals of implementing treatment plans and improving patient outcomes. In the outpatient setting, nurses must consider the regulations imposed by the Centers for Medicare & Medicaid Services when initiating care and billing for services. Nurses, advanced practice nurses, and other clinicians may deliver care ordered by physicians without the physician being physically present in the room. Such services are considered to be "incident to" the physician's care, and there are requirements of supervision that must be met pertaining to the specific care setting. These guidelines and the implications for WOC nurses are the focus of this article.

Direct supervision requirements and incident to services: a primer for the WOC nurse.

The term incident to is defined as services or supplies furnished as an integral (composed of parts that together make a whole), although incidental (relating to or accompanying something more important), part of the provider's professional services rendered during the course of diagnosis or treatment. Such services are often referred to as a nurse visit. Nevertheless, when nurses provide "incident to physician services," the provider must be available to provide support. This article discusses the criteria necessary for nurses to deliver incident to services.

Make sense of wound care billing: turn your cents into reimbursement dollars.

How does a clinician determine appropriate billing for wound care services? For Medicare and Medicaid patients, billing-related regulations are developed and promulgated by the US Centers for Medicare & Medicaid Services (CMS). This article will show how to access and use the CMS Web site as a resource for finding necessary information pertaining to billing guidelines and appropriate codes, including edits that prevent billing multiple procedures together and the use of modifiers that may allow an additional billing. Further discussion focuses on the importance of regular visits to this Web site since it is regularly updated as changes occur in billing or reimbursement policies. Therefore, investing the time to check the site for the latest updates can make a critical difference in your success with reimbursement for wound care services.