TIP OF THE WEEK
Know the revised NPUAP pressure ulcer stages
In February 2007, the National Pressure Ulcer Advisory Panel (NPUAP) redefined the definition of a pressure ulcer and the stages of pressure ulcers, including the original four stages and adding two stages on deep tissue injury and unstageable pressure ulcers. This new staging system is the culmination of over five years of work beginning with the identification of deep tissue injury in 2001. The following is an excerpt from the NPUAP Web site:
PRESSURE ULCER DEFINITION
A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.
PRESSURE ULCER STAGES
Suspected Deep Tissue Injury
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.
Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.
Stage I
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.
The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate "at risk" persons (a heralding sign of risk).
Stage II
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.
Presents as a shiny or dry shallow ulcer without slough or bruising. (Bruising indicates deep tissue injury.)* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
Stage III
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.
The depth of a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible or directly palpable.
Stage IV
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.
The depth of a stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable.
Unstageable
Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.
Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as "the body's natural (biological) cover" and should not be removed.1
ABOUT THE NPUAP STAGING SYSTEM
The staging system was defined by Shea in 1975 and provides a name to the amount of anatomical tissue loss. The original definitions were confusing to many clinicians and lead to inaccurate staging of ulcers associated or due to perineal dermatitis and those due to deep tissue injury.
The proposed definitions were refined by the NPUAP with input from an online evaluation of their face validity, accuracy clarity, succinctness, utility, and discrimination. This process was completed online and provided input to the Panel for continued work. The proposed final definitions were reviewed by a consensus conference and their comments were used to create the final definitions.
"NPUAP is pleased to have completed this important task and look forward to the inclusion of these definitions into practice, education and research", said Joyce Black, NPUAP President and Chairperson of the Staging Task Force.
Online courses for continuing education.
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Fulfill your continuing education goals early in 2008 with Ohio KePRO’s online self-learning modules. These online trainings are free of charge and offer 1 hour of continuing education credits for nurses.
Benefits Improvement and Protection Act
Learn more about BIPA, fast-track appeals, and what you and your organization need to do to respond appropriately. Who should take this course: discharge planners, case managers, social workers, nurses, and administrative staff.
General Pain Principles
Review the basics in pain management including definitions, prevalence, consequences, barriers/ misconceptions, and common approaches. Who should take this course: administrators/CEOs, nurses, social workers, QI personnel, direct care staff, and educators.
General Pressure Ulcer Principles (Coming Soon)
Understand the basics in pressure ulcer management including definitions, prevalence, barriers/misconceptions, and common approaches. Who should take this course: administrators/ CEOs, nurses, social workers, and QI personnel.
To begin, go to www.ohiokepro.com/education/main.asp
RESOURCE SPOTLIGHT
Steps to Accessing CMS Enterprise Applications for Provider Organizations
Centers for Medicare & Medicaid Services’ (CMS) enterprise applications are those hosted and managed by CMS and do not include Fiscal Intermediary (FI)/carrier/Medicare Administrative Contractor (MAC) Internet applications. This one page guide, released in December 2007, provides instructions for registering two staff members for the IACS-PC CMS online application.
IN THE NEWS
HEALTH OF PREVIOUSLY UNINSURED ADULTS AFTER ACQUIRING MEDICARE COVERAGE
December 26, 2007 -- JAMA -- A study released on Wednesday in the Journal of the American Medical Association (JAMA) reveals that the health of uninsured seniors with heart disease or diabetes improved after they became eligible to enroll in Medicare. Adults who previously had insurance upon reaching age 65 received no boost in health status. Read the abstract >>
December 20, 2007 -- FDA -- AM2 PAT, Inc., Angier, North Carolina, is initiating a nationwide recall of one lot of Pre-Filled Heparin Lock Flush Solution USP (5 mL in 12 mL Syringes), Lot # 070926H. The heparin IV flush syringes were found to be contaminated with Serratia marcescens, which resulted in patient infections. The Centers for Disease Control and Prevention (CDC) has confirmed growth of Serratia marcescens from several unopened syringes of this product. This type of bacterial infection could present a serious adverse health consequence that could lead to life-threatening injuries and/or death. Read more >>
NEW CMS E-MAIL LIST FOR FEE-FOR-SERVICE (FFS) PROVIDERS, SUPPLIERS, AND THEIR STAFF
November 8, 2007 -- CMS -- The Centers for Medicare & Medicaid Services (CMS) will be offering a new e-mail update (or listserv) service that delivers Medicare information to Fee-for-Service (FFS) providers, suppliers, and their staff's inboxes. Visitors to www.cms.hhs.gov will be able to sign up to receive updates relevant to Medicare Fee-for-Service providers and suppliers and to receive information on related topics. This new service will allow you to choose between many audience types and subjects of information, such as the National Provider Identifier (NPI), the Physician Quality Reporting Initiative (PQRI), and Preventive Services. Subscribe here >>
COMING ATTRACTIONS
Cardiac Care Concerns Teleconference
February 21, 2008, 1:00 to 2:00 p.m. EST
Dial-in #: 1-866-206-6900 Conference ID: 1182306
Cost: Free
CEUs for nurses are pending.
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CMS Home Health, Hospice & DME Open Door Forum
January 9, 2008, 2:00 p.m. EST
Dial: 1-800-837-1935
Reference Conference ID: 18789483
The History and Evolution of Quality in Healthcare
Tuesday, January 8, 2008, 12:00 to 1:30 p.m. EST
A national teleconference from the Medicare Quality Improvement Organizations.
Presenter: Sharon Eloranta, MD, from the Institute of Healthcare Improvement (IHI)
Cost: Free
Click here to register
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