Staging pressure ulcers

[OKNurse2be]

Hi ya'll. I was hoping someone might help me answer this question. I am trying to determine how to stage a pressure ulcer that gets worse. I know that a healing pressure ulcer remains stage x healing, but what about the pressure ulcer that gets worse? Say for instance a pt has a stage 2, but then when assessed again at a later time is determined that it has gone deeper and could be classified as a stage 3, do you document it as a stage 3? I can't seem to find definitive information on this, so I decided to try and see if someone here had a good answer. To my thinking, you would restage it if it gets worse, but I want to make sure that I am right about that.

[Michaela, RN]

Hi ya'll. I was hoping someone might help me answer this question. I am trying to determine how to stage a pressure ulcer that gets worse. I know that a healing pressure ulcer remains stage x healing, but what about the pressure ulcer that gets worse? Say for instance a pt has a stage 2, but then when assessed again at a later time is determined that it has gone deeper and could be classified as a stage 3, do you document it as a stage 3? I can't seem to find definitive information on this, so I decided to try and see if someone here had a good answer. To my thinking, you would restage it if it gets worse, but I want to make sure that I am right about that.

You should always document what you see. If you don't it will come back to haunt you. If the condition is worsening at any time, document it and report it to the pt's physician.

[OKNurse2be]

Thanks, that makes perfect sense to me.

[Sun0408, ASN, RN]

Check with wound care if you have that service or your P&P. Reason being, in the facilities I have worked at, only the trained can actually stage a pressure ulcer. We can document the site,size etc but not "stage" it.