Pressure ulcer staging

[Babybell]

Have a question about staging past pressure ulcer. The discharge summery papers indicated Left ischial--- stage IV pressure ulcer, s/p flap surgical procedure. On assessment, the site is closed with sutures with JP drain in place. My question is do I?:

a. Put it as stage IV pressure ulcer/ or may be healed stage IV pressure ulcer/ healed staged IV pressure ulcer s/p flap procedure c JP in place. I have been thought that once stage established, the pressure ulcer always stays that stage, it is never downgraded even when it is been healed. In that case is healed through surgical intervention.

b. Put it as UTD because, the site been surgically closed and at assessment time I cannot see the extent of the wound. I have been thought to always put what I see at the time of actual assessment.

c. Or may be I put it as just a surgical wound site on admission and not mention pressure staging at all.

I did option c, but its been bothering me, so I would like to have more opinions on that ..

Thanks so much

[KarenJordan]

IN most settings, it's now considered a surgical wound.

[Esme12, ASN, BSN, RN]

moved to wound care for better response

[agldragonRN]

I would call it a surgical wound as well on my wound sheet and charting. But now that you mentioned this scenario and if I get a patient like that in the future, I will probably include "Per hospital records, surgical wound was previously stage IV." But I will always call it surgical wound in my charting.

[mommy.19, MSN, RN, APRN]

I see your confusion, but you sound very versed in PU staging so, KUDOS! :)

I would definitely do what you did, as well as what the last poster mentioned. It is likely the excision site of the previous stg 4 ulcer or a myocutaneous flap, which either would be referred to as a surgical wound.

[NC29mom, ASN, LPN, RN]

I'm sorry, but I am going to have to disagree with the majority.....I would document it just as the discharge paperwork referred to it as, "L Ischial Stage IV pressure ulcer s/p surgical flap surgical procedure". That in itself, says it all. If you just document as "surgical wound with JP drain", there is no identified underlying cause. There needs to be documentation in this Pt's record indicating this area once had a Stage IV pressure ulcer. You can also document your assessment findings r/t surgical incision, to give further readers an even better idea of what the area looked like.