Pressure Ulcers

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By the WoundSource Editors

Washington, DC – August 30, 2016 – The National Pressure Ulcer Advisory Panel (NPUAP) revised the Pressure Injury Staging System following a consensus conference in April. The response to the changes has been positive. To date, The Joint Commission (TJC) has adopted the new terminology and the Centers for Medicare and Medicaid Services (CMS) has been in discussions with the NPUAP to incorporate the new terminology. The rollout of the changes will be controlled by these agencies.

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Thomas Serena's picture
leadership in wound care

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

"I believe we possess all the resources and talents necessary. But the facts of the matter are that we have never made the national decisions or marshaled the national resources required for such leadership."
-John F. Kennedy May 25, 1961

Cheryl Carver's picture
Stage 1 Pressure Injury - Darkly Pigmented Skin

By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

I have worked all over the country as an educator. The same gaps in education arise everywhere. A few years ago, I began teaching skin color awareness as part of my course curriculum. I feel strongly about it being a part of my inservices and course education. Understanding skin color as it relates to assessment is critical in the prevention of pressure injuries.

Margaret Heale's picture
advancing wound care nursing skills

By Margaret Heale, RN, MSc, CWOCN

I was not at the April National Pressure Ulcer Advisory Panel (NPUAP) meeting, but I do think some of critical commentary that has followed the announcement of the pressure injury staging system changes is flawed. Clearly designating the thickness of an injury to a defined wound stage makes sense and communicates a severity. All the NPUAP have done is clarify some detail that clinicians have had to manage previously, within a gray area. It is not the responsibility of the NPUAP, researchers or clinicians at the bedside to make up definitions to fit coding or legislators. It is important that researchers and bedside clinicians provide the Centers for Medicare & Medicaid Services (CMS) and legislators with research demonstrating how and why pressure ulcers occur.

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Mary Ellen Posthauer's picture
pressure ulcer terminology

By Mary Ellen Posthauer RDN, CD, LD, FAND

The April National Pressure Ulcer Advisory Panel (NPUAP) consensus conference resulted in a terminology change from pressure ulcer to pressure injury, and also validated new terminology which more accurately describes pressure injury in intact and ulcerated skin. The previous staging system described both Stage 1 and Deep Tissue Injury as injured intact skin and the other stages described open ulcers. There has been confusion because the definitions for each of the stages referred to the injuries as "pressure ulcers". The term "suspected" was removed form the Deep Tissue Injury diagnostic label and Arabic numbers are now used instead of roman numerals.

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Cheryl Carver's picture
patient repositioning for pressure injury prevention

By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

I am very passionate about wound care, but pressure injury (pressure ulcer) prevention and awareness is at the top of my list for many reasons. My mother passed away in my arms at the young age of 47 due to complications of diabetes, amputation, and three pressure injuries. My mother's hospital-acquired pressure injuries were avoidable.

Terri Kolenich's picture
compliant pressure ulcer documentation

By Terri Kolenich, RN, CWCA, AAPWCA

It has been a long week. The CMS state survey team entered your facility Sunday afternoon at 2pm. Thursday is finally here and the state survey exit meeting is only minutes away. Your heart is heavy and your mind is occupied with thoughts of an in-house acquired, stage IV pressure ulcer. The surveyor observed your dressing change and reviewed every bit of documentation pertaining to this stage IV pressure ulcer. The burning in your gut has completely convinced your brain that your facility will receive the dreaded F-Tag 314 because of this in-house acquired pressure ulcer.

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WoundSource Editors's picture

By the WoundSource Editors

Decubitus ulcers are an open skin wound sometimes known as a pressure ulcer, bed sore, or pressure sore. A decubitus ulcer forms where the pressure from body the body's weight presses the skin against a firm surface, such as a bed or wheelchair. Pressure cuts off the blood supply to the skin and injures tissue cells. Initially, the skin usually looks red or a bit discolored. Eventually, if the pressure isn't relieved, the skin breaks down and the tissue dies (necrosis). With proper diagnostic care and treatment, most people with a decubitus ulcer have a good prognosis for recovery

Mary Ellen Posthauer's picture
Nutrition and wound healing

By Mary Ellen Posthauer RDN, CD, LD, FAND

Congratulations to Bruce Ruben, MD, for his #1 WoundSource blog for 2015; Wound Healing: Reasons Wounds Will Not Heal. I certainly concur with Dr. Ruben that inadequate nutrition is an often-overlooked reason for delayed wound healing.

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Bruce Ruben's picture
Nutrition and protein intake

By Bruce E. Ruben MD

A day doesn't go by that I'm not bombarded with information on the newest diet, the latest exercise trend or the fastest way to get in shape. My email inbox opens with message subjects like "click here to drop 10 pounds fast" or "how to get a Kardashian body without surgery." I overhear women at a local breakfast haunt order egg whites instead of whole eggs, because they contain less fat and they are worried about gaining weight. How about the latest craze of ordering sandwiches wrapped in lettuce because everyone is afraid of the dreaded carbohydrates? Our culture is so focused on losing weight, getting in shape, and looking like the latest model on the cover of Vogue or GQ that we have lost sight of what is healthy.

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