The logic flags address two types of situations:  when a skin issue has been reported in the MDS for a resident but no occurrence record is found for it in RiskWatch^®; and conversely, when a skin occurrence exists in RiskWatch^® but it is not reflected in the MDS assessment for the resident. 

The full content of the new logic flags are shown below:

If any of the following are reported on the MDS, a skin occurrence report that is within 10 days of the ARD date or on the day of the ARD date should be completed.

If M4a=1 and no bruise or abrasion occurrence report in RiskWatch^®

Problem: The assessment states that the resident has a bruise and or an abrasion and there is no bruise or abrasion RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a bruise or abrasion, correct the MDS.
2. If the resident has a bruise or an abrasion, complete a RiskWatch^® occurrence report.

Impact: Without a thorough investigation of the injury using the RiskWatch^® occurrence reporting and investigative tool, the facility could be cited with an F-309, Quality of Care,
“Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being” and/or F-tag 225 that includes that the facility must ensure that all injuries of unknown source are reported immediately to the administrator of the facility and to other officials in accordance with state law.

If M4b=1 and no burn occurrence report in RiskWatch^®
Problem: The assessment states that the resident has a burn and there is no burn RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a burn, correct the MDS.
2. If the resident has a burn, complete a RiskWatch^® occurrence report.

Impact: Without a thorough investigation of the injury using the RiskWatch^® occurrence reporting and investigative tool, the facility could be cited with an F-309, Quality of Care,
“Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being” and/or F-tag 225 that includes that the facility must ensure that all injuries of unknown source are reported immediately to the administrator of the facility and to other officials in accordance with state law.

If M4f=1 and no skin tear or cut report in RiskWatch^®
Problem: The assessment states that the resident has a skin tear or cut and there is no skin tear or cut RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a skin tear or cut, correct the MDS.
2. If the resident has a skin tear or cut, complete a RiskWatch^® occurrence report.

Impact: Without a thorough investigation of the injury using the RiskWatch^® occurrence reporting and investigative tool, the facility could be cited with an F-309, Quality of Care,
“Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being” and/or F-tag 225 that includes that the facility must ensure that all injuries of unknown source are reported immediately to the administrator of the facility and to other officials in accordance with state law.

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If any of the following RiskWatch^® occurrences were reported within 10 days of the ARD date or on the day of the ARD date.

M4a=0 and a bruise or abrasion has been reported in RiskWatch^®
Problem: The assessment states that the resident does not have a bruise and or an abrasion and there is a RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a bruise or abrasion, check in RiskWatch^® to determine if a report was mistakenly made on this resident.
2. If the resident has a bruise or an abrasion, correct the MDS.

Impact: Inaccurate assessments may cause the facility to receive a deficiency for F-tag 278, “The assessment must accurately reflect the resident’s status.”

M4b=0 and a burn has been reported in RiskWatch^®
Problem: The assessment states that the resident does not have a burn and there is a RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a burn, check in RiskWatch^® to determine if a report was mistakenly made on this resident.
2. If the resident has a burn, correct the MDS.

Impact: Inaccurate assessments may cause the facility to receive a deficiency for F-tag 278, “The assessment must accurately reflect the resident’s status.”

M4f=0 and a skin tear or cut has been reported in RiskWatch^®
Problem: The assessment states that the resident does not have a skin tear or cut and there is a RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a skin tear or cut, check in RiskWatch^® to determine if a report was mistakenly made on this resident.
2. If the resident has a skin tear or cut, correct the MDS.

Impact: Inaccurate assessments may cause the facility to receive a deficiency for F-tag 278, “The assessment must accurately reflect the resident’s status.”

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If a RiskWatch^® occurrence was reported within 92 days of the ARD date or on the day of the ARD date. This would include the following skin occurrence types:  Arterial Ulcer, Diabetic Neuropathic Ulcer.

If M1a>0 M2a=0 and M2b=0 and an ulcer has been reported in RiskWatch^®
Problem: The assessment states that the resident has a Stage I ulcer and there is no Stage I RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a Stage I ulcer, correct the MDS.
2. If the resident has a Stage I ulcer, complete a RiskWatch^® occurrence report.
3. If an occurrence report has been completed, review your care plan to ensure all appropriate care is being implemented.

Impact: Without a thorough report and investigation of the Stage I ulcer, the facility could be cited with a deficiency in F-309, that states each resident must receive, and the facility must provide, the necessary care and services and provides documentation that the pressure ulcer was “unavoidable.”

If M1b>0 M2a=0 and M2b=0 is reported on the MDS and no RiskWatch^® occurrence report
Problem: The assessment states that the resident has a Stage II ulcer and there is no Stage II RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a Stage II ulcer, correct the MDS.
2. If the resident has a Stage II ulcer, complete a RiskWatch^® occurrence report.
3. If an occurrence report has been completed, review your care plan to ensure all appropriate care is being implemented.

Impact: Without a thorough report and investigation of the Stage II ulcer, the facility could be cited with a deficiency in F-309, that states each resident must receive, and the facility must provide, the necessary care and services and provides documentation that the pressure ulcer was “unavoidable.”

If M1c>0 M2a=0 and M2b=0 is reported on the MDS and no RiskWatch^® occurrence report
Problem: The assessment states that the resident has a Stage III ulcer and there is no Stage III ulcer RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a Stage III ulcer, correct the MDS.
2. If the resident has a Stage III ulcer, complete a RiskWatch^® occurrence report.
3. If an occurrence report has been completed, review your care plan to ensure all appropriate care is being implemented.

Impact: Without a thorough report and investigation of the Stage III ulcer, the facility could be cited with a deficiency in F-309, that states each resident must receive, and the facility must provide, the necessary care and services and provides documentation that the pressure ulcer was “unavoidable.”

If M1d>0 M2a=0 and M2b=0 is reported on the MDS and no RiskWatch^® occurrence report
Problem: The assessment states that the resident has a Stage IV ulcer and there is no Stage IV RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a Stage IV ulcer, correct the MDS.
2. If the resident has a Stage IV ulcer, complete a RiskWatch^® occurrence report.
3. If an occurrence report has been completed, review your care plan to ensure all appropriate care is being implemented.

Impact: Without a thorough report and investigation of the Stage IV ulcer, the facility could be cited with a deficiency in F-309, that states each resident must receive, and the facility must provide, the necessary care and services and provides documentation that the pressure ulcer was “unavoidable.”

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If any of the RiskWatch^® occurrence reports were reported within 92 days of the ARD date or on the day of the ARD date. This would include the following skin occurrence types: Arterial Ulcer, Diabetic Neuropathic Ulcer.

M1a-d=0 M2a=0 and M2b=0 and an ulcer has been reported in RiskWatch^®
Problem: The assessment states that the resident does not have an ulcer and there is an ulcer RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have an ulcer, check in RiskWatch^® to determine if a report was mistakenly made on this resident.
2. If the resident has an accurate ulcer RiskWatch^® occurrence, correct the MDS.

Impact: Inaccurate assessments may cause the facility to receive a deficiency for F-tag 278, “The assessment must accurately reflect the resident’s status.”

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If any of the following are reported on the MDS, a skin occurrence report that is within 92 days of the ARD date or on the day of the ARD date should be completed.

M2a>0 is reported on the MDS and no pressure ulcer occurrence report
Problem: The assessment states that the resident has a pressure ulcer and there is no RiskWatch^® pressure ulcer occurrence report.

Resolution: 1. If the resident does not have a pressure ulcer, correct the MDS.
2. If the resident has a pressure ulcer, complete a RiskWatch^® occurrence report.
3. If an occurrence report has been completed, review your care plan to ensure all appropriate care is being implemented.

Impact: Without a thorough report and investigation of the ulcer, the facility could be cited with a deficiency in F-309, that states each resident must receive, and the facility must provide, the necessary care and services and provides documentation that the pressure ulcer was “unavoidable,” and/or be cited with a deficiency in F-314, “A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.”

If M2b>0 is reported on the MDS and no venous stasis ulcer occurrence report
Problem: The assessment states that the resident has a venous stasis ulcer and there is no RiskWatch^® venous stasis ulcer occurrence report.

Resolution: 1. If the resident does not have a venous stasis ulcer, correct the MDS.
2. If the resident has a venous stasis ulcer, complete a RiskWatch^® occurrence report.
3. If an occurrence report has been completed, review your care plan to ensure all appropriate care is being implemented.

Impact: Without a thorough report and investigation of the venous stasis ulcer, the facility could be cited with a deficiency in F-309, that states each resident must receive, and the facility must provide, the necessary care and services and provides documentation that the venous stasis ulcer was “unavoidable.”

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If a pressure ulcer was reported within 92 days of the ARD date or on the day of the ARD date.

M2a=0 and a pressure ulcer has been reported in RiskWatch^®
Problem: The assessment states that the resident does not have a pressure ulcer and there is a pressure ulcer RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a pressure ulcer, check in RiskWatch^® to determine if a report was mistakenly made on this resident.
2. If the resident has an accurate pressure ulcer RiskWatch^® occurrence, correct the MDS.

Impact: Inaccurate assessments may cause the facility to receive a deficiency for F-tag 278, “The assessment must accurately reflect the resident’s status.”

M2b=0 and a venous stasis ulcer has been reported in RiskWatch^®
Problem: The assessment states that the resident does not have a venous stasis ulcer and there is a venous stasis ulcer RiskWatch^® occurrence report.

Resolution: 1. If the resident does not have a venous stasis ulcer, check in RiskWatch^® to determine if a report was mistakenly made on this resident.
2. If the resident has an accurate venous stasis ulcer RiskWatch^® occurrence, correct the MDS.

Impact: Inaccurate assessments may cause the facility to receive a deficiency for F-tag 278, “The assessment must accurately reflect the resident’s status.”