TIP OF THE WEEK

Know the new NPUAP pressure ulcer stages

 

Excerpted from NPUAP Web site, 2007.

 

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.

 

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.

* Bruising indicates suspected deep tissue injury

 

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.

 

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.

 

For more information, contact npuap.org or 202-521-6789

 

 

 

 

IN THE NEWS

 

STATE CONSIDERS UNIFIED POT OF MEDICAID MONEY FOR LONG-TERM CARE

May 12, 2007 -- Cleveland Plain Dealer -- The Ohio Department of Aging has begun a study that may lead to a unified pot of Medicaid money for care for the elderly -- including in-home services and those provided by nursing homes, said Barbara Riley, director of the department. "Instead of filling slots for various programs, we would let people choose what they need," she said in a recent visit to Cleveland. "It would be based on consumer choice." Read more >>

 

CMS SEEKS TO BEGIN 'PROFILING' INEFFICIENT PHYSICIANS

May 11, 2007 -- Kaiser Network -- The Centers for Medicare & Medicaid Services (CMS) has the data and computer capacity to identify physicians who are inefficient compared with their colleagues and as early as mid-2008 might begin to contact those physicians and ask them to become more efficient, according to recent testimony by Herbert Kuhn, acting deputy administrator of the agency on Thursday before a House subcommittee hearing, CQ HealthBeat reports.

 

At a House Ways and Means Subcommittee on Health hearing, Kuhn said that identification of inefficient physicians, or "profiling," would involve a comparison of the number of tests ordered by physicians for certain types of patients with the number ordered by colleagues in cases that have the same outcome. Read more >>

 

STUDY: QIO PROGRAM IS ‘GOOD VALUE FOR HEALTH CARE DOLLARS’

May 8, 2007 -- American Health Quality Association -- In a study released today, researchers found that Quality Improvement Organization (QIO) program efforts in nursing homes were “a very sound investment” for Medicare, costing significantly less than $10,000 per quality-adjusted life year (QALY). In the U.S., a QALY falling between $50,000 and $100,000 is commonly considered a good value.

 

Published in the Spring 2007 edition of Health Care Financing Review, the study, “Medicare’s Quality Improvement Organization Program Value in Nursing Homes,” attempts to answer the question, are the benefits of the QIO program worth Medicare’s investment? The answer, the authors conclude, is “yes.” Read more (PDF) >>

 

STATES' SPENDING MAY HELP KEEP CHILDLESS SENIORS INDEPENDENT

May 8, 2007 -- Newswire -- Seniors who do not have children to help care for them are less likely to have to go into a nursing home if they live in a state that spends more on home- and community- based services, researchers have found. Researchers at the University of Illinois at Chicago report the finding in the May 11 issue of the Journals of Gerontology: Social Sciences. Read more >>

 

REPORT PROJECTS FUTURE NEED FOR LONG-TERM CARE

May 7, 2007 -- Newswire -- Providing long-term care to older adults is a growing challenge for American families. About 10 million people 65 and older now depend on such services, and that number is expected to double by 2040. A new report from the Urban Institute projects the number and percentage of people 65 and older with disabilities and their use of long-term care services. The analysis shows how changes in disability levels, financial resources, their adult children’s availability, and other factors will affect older adults’ demand for paid and unpaid long-term care services. Read more >>

 

 

OHIO KEPRO EVENTS

 

THE GOOD APPLES: TIPS FOR ATTRACTING AND RETAINING THE RIGHT EMPLOYEES

In this half-day workshop, we will delve into key strategies for improving workforce retention in the nursing home, including:

• The impact of turnover and absenteeism on an organization and what you can do about it.
• Strategies to improve the hiring and orientation process.
• Motivating employees and improving staff satisfaction.
• Setting goals and measure improvement in workforce retention.

Who should attend: Directors of Operations, Directors of Nursing, Nursing Home Administrators, Staff Development, and Human Resources.

 

7/11 – Cincinnati		7/24 – Wooster
7/12 – Springfield		8/7 – Boardman
7/17 – Cambridge		8/15 – Columbus
7/19 – Sylvania		8/21 – Wellston

 

Save these dates and register today!

 

 

INDUSTRY EVENTS

 

30th Annual Nursing Assistant Convention and Recognition Program

June 20, 2007, Akron, OH

 

Navigating the MDS Through the Ohio Medicaid Reimbursement System

Ohio Department of Job and Family Services
June 11, 2007 or August 23, 2007
Call Cheryl Robertson at (614) 466-9088 for more information.

 

Medicare Learning Network: Learning resources and products for the healthcare professional.

 

Alzheimer’s Association Training Events

 

AOPHA Events

 

Case Western Reserve University School of Medicine Courses

 

Kendal® Outreach

 

Ohio Department of Health, Technical Assistance Program – New Programs

 

Ohio Health Care Association Events

 

 

 

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