wound staging

  1. Hello to all!
    I recently attended a Wound seminar, the speaker did a great job with wound staging. she explained rationale behind not reverse staging- ask me sometime.
    MY QUESTION IS: Do you nurses stage patients pressure sores on assessment, or if they develop or do you just describe the wound and all the asmt that goes along with it?? I find in my agency there is not alot of staging that goes on. perhaps it is because nurses are uneasy with staging?? After this seminar I feel we should be staging wounds. what do you think?
    thanks.
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  2. 6 Comments

  3. by   funsunsue
    Thanks Becky,
    I did know most of that. the seminar I went to said to document "unable to stage due to eschar. Im not using mds format in home health, but nursing home and rehab facilities are required to stage regardless. their wording should include no history avail on wound due to regulations wound is staged at a 2, 3 etc.

    thanks for pointing out that you cant stage unless you did witness the "birth of the wound".
  4. by   Rebecca Braune
    Dear Funsunsue,
    I've been a nurse half my life but I finally learned at a wound care seminar that wounds should only be staged by a nurse or an M.D. if they witnessed it as it was developing. Example: You admit a pt that has left a rehab and/or nursing home and they have a wound that's granulating nicely, and it may only involve the dermis or epidermis layers of the skin. It's far along enough that it can now be taken care of at home. What you may not know unless it was reported to you is that it may have started out as stage III or even a stage IV, in which case it would be healing stage III or IV. What ever it's deepest staqe is what it will always be. Upon healing it will be a healed stage "what ever". Also, and I may be telling you something you already know, any wound that needs to be debrided upon your initial assessment cannot be staged until it has been done so. You cannot know what's under there until you look. Hope this helps answer your question. Becky RN.
  5. by   nightstar41
    Hi! We tend not to describe wound care by stages as there is too much discreptancy on the staging value based on who does it. So, we describe the wound by size, appearance, smell, amount and color of drainage, presence and color of eschar, and amount of granulation tissue. Also, using the stage system is also left to personal interpretation...and can cause confusion on how the wound is actually doing. I will often refer to the staging system for the type of dressing I should use but only as a guide.

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    nightstar
  6. by   Richard Dropski
    The staging of pressure wounds is going to be critical when PPS starts in October as the stage will impact GREATLY on reimbursement. I encourage everyone to get very familiar with doing this accurately.
  7. by   Mijourney
    Hi,
    Are any of you specialists in wound care? One of the companies I worked for employed a full-time ET nurse. She was frequently consulted for wound care evals and instructions in staging as our company required us to fill out a separate skin assessment form that included staging of any wounds.
  8. by   elizasmom
    Quote from Mijourney
    Hi,
    Are any of you specialists in wound care? One of the companies I worked for employed a full-time ET nurse. She was frequently consulted for wound care evals and instructions in staging as our company required us to fill out a separate skin assessment form that included staging of any wounds.
    Hi. I have been a ET nurse (now called a CWOCN) for 9 years and work at 2 hospitals as a contract service. As far as staging goes, one of the basic things I see done a lot is understaging. For instance, a wound labeled a st II with 60% slough. The main difference is a wound with slough almost always heals by scarring (making it a stage III/IV) vs reepithialization (st I/II). It is also a problem with wounds that are not pressure to be staged. I am not sure what you are specifically asking, but as far as staging, the rule of slough is usually appropriate. Hope this helps.

    Jane

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