A deep tissue injury (DTI) is commonly mistaken for a stage 1 pressure ulcer or hematoma. This is a serious mistake and can have a profound impact on patient outcomes, liability, and reimbursement.
What is a deep tissue injury (DTI)?
Deeper, full-thickness damage to underlying tissue that may appear as purple areas or dark necrotic tissue should not be confused with Stage 1 pressure ulcers. The National Pressure Ulcer Advisory Panel has defined wounds such as these as;
A pressure-related injury to the subcutaneous tissue below intact skin. Initially, these injuries have the appearance of a deep hematoma (NPUAP, 2002).
DTIs require rapid identification as they can rapidly progress to stage 3 and 4 pressure ulcers despite aggressive and optimal treatment.
How are DTIs formed?
Fleck (2007) explains that DTIs form over areas of bony prominence and occur from the inside out. Superficial damage is not seen until later, when the tissue undergoes necrosis, reaching the outer layer of skin and resulting in the formation of an external wound. Furthermore, he emphasizes that DTIs can be differentiated from stage 1 ulcers by their rapid deterioration despite adequate care.
What are the legal implications of DTIs?
ICDs that are not recognized for what they are may have legal implications due to their ability to deteriorate despite strict wound management practices. They result in increased costs and hospitalization, not to mention the pain and suffering of the patient who develops one of these injuries, putting the healthcare professional and facility at risk of litigation.
Salcido (2008) discusses current Medicare changes that will take effect on October 1, 2008. These changes will have a major impact on how hospitals are financed. With respect to wound care, pressure ulcers will be considered hospital acquired (and therefore not reimbursed) unless these wounds are documented within 48 hours of admission. We now have a responsibility as healthcare professionals to ensure that these wounds never develop, and if they do, they must be well documented and treated aggressively. This new policy requires us to examine our wound care management practices.
Documentation of DTI’s
Wounds suspected of being a DTI should be given a complete description and the word -DTI- should be mentioned. For those professionals working in long-term care with the Minimum Data Set (MDS) documentation system, the word -unstaging- should be used to describe those wounds that are suspicious for DTI. Full and ongoing documentation is crucial with respect to ICDs, as their rapid deterioration can make these injuries particularly tempting targets for litigation.
Education is the key to the recognition and management of STDs
Understanding the etiology of DTIs and learning to differentiate these wounds from bruises, bruises, and other closed wounds that may have a similar appearance is the key to the prevention and treatment of these wounds, which also have the potential for significant morbidity for patients. . as potentially litigious.