Key Information For Quality, Risk Management, Defense and Plaintiff Counsels
COVID-19 related skin injuries may go unrecognized and are being confused with pressure-related injuries. This erroneous identification may lead to incorrect reporting to the Centers for Medicare and Medicaid Services (resulting in subsequent limited reimbursement), nursing staff providing inadequate care, and patient and family concerns about appropriate wound care.
The Academy of Medical-Surgical Nurses recently sponsored a webinar entitled COVID-19: One year into the Pandemic. The overview of COVID 19 was presented by Lynne Kokoczka MSN, APRN-CNS, ACCNS-AG, CCRN to a national audience.
Purple Skin And Toes In COVID-19 Positive Patients
One recent development identified in the presentation is the emergence of wounds that initially appear as purple skin and toes observed on patients who are COVID-19 positive. These wounds are not pressure point related. The National Pressure Advisory Panel (NPIAP) now provides guidelines to assist wound care clinicians in determining if the purple skin is a deep tissue pressure injury or a cutaneous manifestation of COVID-19.
Identifying Whether Wounds Are Related To Nursing Care Issues
Without proper diagnosis, these wounds could result in misidentification of nursing-related care issues. Barriers to proper identification of these lesions include: patient instability, making it difficult to obtain a skin biopsy, and limited or no access to a dermatologist to interpret the biopsies.
COVID-19 Dermatology Registry
The American Academy of Dermatology has set up a COVID-19 Dermatology Registry without patient identifiers in order to collect data on:
- COVID-19 patients who develop dermatologic manifestations
- existing dermatology patients who then develop COVID-19 dermatologic manifestations
- patients who received the COVID-19 vaccine and developed a skin reaction.
Current studies are ongoing regarding these findings internationally. The provided references are as follows:
- Galván Casas, C., Català, A., Carretero Hernández, G., Rodríguez‐Jiménez, P., Fernández‐Nieto, D., Rodríguez‐Villa Lario, A., … & García‐Gavín, J. (2020). Classification of the cutaneous manifestations of COVID‐19: A rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology, 183, 71-77.
- Marzano, A.V., Cassano, N., Genovese, G., Moltrasio, C., & Vena, G.A. (2020). Cutaneous manifestations in patients with COVID-19: A preliminary review of an emerging issue. British Journal of Dermatology. doi:10.1111/bjd.19264 [Published online ahead of print, 2020 Jun 1]
- National Pressure Injury Advisory Panel (2020). Skin manifestations with COVID-19: The purple skin and toes that you are seeing may not be deep tissue pressure injury: An NPIAP white paper. Retrieved from https://cdn.ymaws.com/npiap.com/resource/resmgr/white_papers/COVID_Skin_Manifestations_An.pdf
- Young, S. & Fernandez, A.P. (2020). Skin manifestations of COVID-19. Cleveland Clinic Journal of Medicine, May 2020. doi:10.3949/ccjm.87a.ccc031