Every sensory entry should make the skilled need explicit. The medical-necessity formula combines the skilled action, the RN-level reason it required a nurse, and the measurable effect on the patient or the plan.
The formula
skilled action + RN-level clinical reason + measurable effect on the patient’s condition or plan
Worked examples
• Skilled monofilament testing was required to identify new loss of protective sensation at the forefoot, triggering intensified foot-protection teaching and a podiatry referral that prevented an ulcer in a high-risk diabetic foot.
• Skilled inspection of an insensate foot was required to find a 1 cm painless ulcer the patient could not feel, prompting offloading and provider notification that initiated wound care before the lesion deepened (cross-reference Wounds).
• Skilled recognition of sudden numbness with arm weakness was required to run BE-FAST and activate EMS, identifying a possible stroke and routing the patient to time-critical care (cross-reference Neurological).
