staging pressure ulcers

RNSue · Mar 6, 2001

Catskillrn, A pressure ulcer that is healing or has healed over all the way should still be considered at the stage of the original level of damage. For example, A stage III pressure ulcer over the right trochanter is still a Stage III even if it is almost covered with new epithelial tissue. Even if it is healed completely and covered over with epithelial tissue it is still a Healed Stage III Pressure Ulcer. The reason for this is that the tissue that fills in the "hole" is granulation tissue which does not have the same integrity as the original tissue(muscle). The patient will always have a greater risk of recurrance at the same site for this reason. Even if the ulcer does not re-occur at the site for years, the patient would still be considered to have a Healed Stage III. That lets you know that that site needs extra pressure reducing measures. Hope this helps!

MQ Edna · Mar 6, 2001

Originally posted by catskillrn:
how are you all staging your pressure ulcers? Is a stage 3 always a healing stage 3 until resolved? or is it a 3, then a 2, then a 1, then resolved? thanks!

I agree that ulcers should be staged as healing ulcers. However,for Medicare/Medicaid reimbursement we are forced to reverse stage. If we were to stage an ulcer as a Stage 4 and recorded this but

was being treated as Stage 2 we would be paid

for something that we shouldn't. Auditors would consider this fraud. Once again regulators aren't changing with the times.

mustangsheba · Mar 6, 2001

Also, we need to remember that if it looks like a stage II, it's probably a III, and if it looks like a III, it's probably a IV.

2LTCnurses · Jul 4, 2001

Originally posted by cindy loetro

I agree that ulcers should be staged as healing ulcers. However,for Medicare/Medicaid reimbursement we are forced to reverse stage. If we were to stage an ulcer as a Stage 4 and recorded this but
was being treated as Stage 2 we would be paid
for something that we shouldn't. Auditors would consider this fraud. Once again regulators aren't changing with the times.

Because of this problem, we solved it by our wound measurement sheets. Our wounds are measured on a weekly basis and our sheets have a column that states the actual stage (because you can't downstage a pressure ulcer) and another column that states "visualized stage" that week, which covers the reimbursement issue. It satisfies both issues.

Catsrule16, RN · Jul 5, 2001

Have you heard of the PUSH tool??? New tool for measuring and staging pressure ulcers. Can be found at National Presure Ulcer Advisory Panel It assigns a number score between 1 - 17. the higher the number the worse the wound is... i.e. Stage IV, PUSH score 14. The score is reached by width, depth and length measurements as well as tissue type and drainage. Check it out. MDS 3.0 will be using the PUSH tool.

tjoslon · Mar 22, 2005

i have a resident with a pressure ulcer it is pink around the edges and has black/brown area in the center, the center is soft but the whole area is closed. how would you stage this ulcer.

mora gomez · Mar 30, 2005

i have a resident with a pressure ulcer it is pink around the edges and has black/brown area in the center, the center is soft but the whole area is closed. how would you stage this ulcer.

With your description of the Ulcer, I think and am very sure, your Resident has dry necrotic ulcer.This will heal very long or never at all if it is closed.You have to debride it. :nurse: mora

mora gomez · Mar 30, 2005

Catskillrn, A pressure ulcer that is healing or has healed over all the way should still be considered at the stage of the original level of damage. For example, A stage III pressure ulcer over the right trochanter is still a Stage III even if it is almost covered with new epithelial tissue. Even if it is healed completely and covered over with epithelial tissue it is still a Healed Stage III Pressure Ulcer. The reason for this is that the tissue that fills in the "hole" is granulation tissue which does not have the same integrity as the original tissue(muscle). The patient will always have a greater risk of recurrance at the same site for this reason. Even if the ulcer does not re-occur at the site for years, the patient would still be considered to have a Healed Stage III. That lets you know that that site needs extra pressure reducing measures. Hope this helps!

A VERY EXCELLENT INFORMATION! I am a wound nurse expert here in switzerland and you are RIGHT. :nurse: mora

CapeCodMermaid, RN · Mar 30, 2005

You may always document a healing pressure ulcer as "a stage 3 that presents clinically as a stage 2"....and IMO...that PUSH tool is too long to be used in every day practice