You Asked: Are nursing homes required to repeatedly measure a resident’s bruise until it resolves?
We Answered: There is no CMS requirement that a bruise be repeatedly measured at every assessment until it resolves. CMS expects facilities to develop policies consistent with accepted clinical standards and directs surveyors to evaluate whether those policies are being followed when concerns are identified. In Ohio, citations related to bruising and skin impairment have not focused on the failure to repeatedly measure a bruise, but rather on failures to identify, assess, and appropriately address the bruise when it occurs. When a bruise is identified, the facility should complete and document an appropriate initial assessment, which may include the location, approximate size, color and appearance, pain or tenderness, swelling, skin integrity, and known or suspected cause.
Ongoing monitoring should focus on the resident’s clinical condition and progression of the bruise, such as whether it is stable, resolving, enlarging, becoming more painful, developing increased swelling, or resulting in skin breakdown. Repeat measurement may be appropriate when the bruise appears to be enlarging or when otherwise clinically indicated.
Facilities should also evaluate the circumstances surrounding an unexplained or suspicious bruise and follow applicable requirements for investigation and reporting when abuse, neglect, injury of unknown source, or another reportable event is suspected.