Frequently Asked - npuap.org

1 Frequently Asked Questions about Pressure Injury Staging2/20/20181 2018 National Pressure ulcer Advisory Panel | Asked Questions about Pressure Injury StagingFebruary 20, 2018, 1 to 2 pm ETScott Bolhack, MD, MBA, CMD, CWSP, FACP, FAAPJ anet Cuddigan. PhD, RN, CWCN, FAANJ oyce A. Pittman, PhD, ANP-BC, FNP-BC, MissionThe National Pressure ulcer Advisory Panel (NPUAP) is the nation s leading scientific expert on pressure injury prevention and treatment. Our goal is to insure improved patient health, and to advance public policy, education and research. 2017 National Pressure ulcer Advisory Panel | Asked Questions about Pressure Injury Staging2/20/20182 Reduced Price for theInternational Guideline!NPUAP in collaboration with the European Pressure ulcer Advisory Panel (EPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA) has worked to develop a pressure injury prevention and treatment the Clinical Practice Guideline and Quick Reference Guide.

2 The price of these books have recently been your copy today at 2017 National Pressure ulcer Advisory Panel | E-Versions of theInternational Guideline!The Clinical Practice Guideline and various chapters within the Guideline are now available as downloadable publications! Some of the chapters include bariatric individuals, critically ill patients and more!Prices for these e-version publications range from $10 to $ your copy today at 2017 National Pressure ulcer Advisory Panel | Asked Questions about Pressure Injury Staging2/20/20183 NPUAP MonographReleased in November 2012, the 254-page, 24 chapter monograph, Pressure Ulcers: Prevalence, Incidence and Implications for the Futurewas authored by 27 experts from NPUAP and invited authorities and edited by NPUAP Alumna Dr. Barbara Pieper. The monograph focuses on pressure ulcer rates from all clinical settings and populations; rates in special populations; a review of pressure ulcer prevention programs; and a discussion of the state of pressure ulcers in America over the last the monograph today at E-version$49 Individual Chapters$ 2017 National Pressure ulcer Advisory Panel | Educational Slide 2017 National Pressure ulcer Advisory Panel | Pressure Injury Definition and Stages Prevention of Pressure Injury Treatment of Pressure InjuryEach downloadable slide set includes presentations, speaker notes and handoutsPurchase the slide sets today at Asked Questions about Pressure Injury Staging2/20/20184 2016 National Pressure ulcer Advisory Panel | 2016 National Pressure ulcer Advisory Panel | Asked Questions about Pressure Injury Staging2/20/20185 THANK YOU to the following companies that have provided support for this webinar!

3 Abbott Nutrition Acelity(KCI) American Medical Technologies Arjo Bruin Biometrics (BBI) Coloplast EHOB First Quality Hill-Rom HoverTechInternational InvacareThe NPUAP webinar commercial supporters did not have any input regarding the content of this YOU to the following companies that have provided support for this webinar! Leaf Healthcare Medline Molnlycke Permobil Select Medical Sizewise Span America Stryker Tamarack Habilitation Technologies WellsenseThe NPUAP webinar commercial supporters did not have any input regarding the content of this Asked Questions about Pressure Injury Staging2/20/20186 Faculty Disclosures Scott Bolhack, MD, MBA, CMD, CWSP, FACP, FAAP Janet Cuddigan. PhD, RN, CWCN, FAAN Joyce A. Pittman, PhD, ANP-BC, FNP-BC, CWOCNThe webinar faculty have listed no financial interest/arrangements that would be considered a conflict of Committee Disclosures Janet Cuddigan, PhD, RN, CWCN, FAAN Colin Dworak Mary Litchford, PhD, RD, LDN Joyce A.

4 Pittman, PhD, ANP-BC, FNP-BC, CWOCN Tracey L. Yap PhD, RN, WCC, CNE, FAANThe planning committee members have listed no financial interest/arrangements that would be considered a conflict of interest. 2017 National Pressure ulcer Advisory Panel | Asked Questions about Pressure Injury Staging2/20/20187 Objectives Describe the 2016 NPUAP Pressure Injury Staging System. Discuss answers to Frequently Asked questions about differentiating among pressure injury stages. Discuss clinical principles and strategies for differentiating pressure injuries from other types of Overview of 2016 NPUAP Pressure Injury Staging SystemJanet Cuddigan, PhD, RN, CWCN, FAANF requently Asked Questions about Pressure Injury Staging2/20/20188 Pressure Injury Definition15A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful.

5 The injury occurs as a result of intense pressure, prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue. Stage 1 Pressure Injury: Non-blanchable erythema of intact skinIntact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchableerythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury. 2016 National Pressure ulcer Advisory Panel | Asked Questions about Pressure Injury Staging2/20/20189 Blanchable vs. Non-BlanchablePhoto courtesy of Dr. Tom DefloorPhoto courtesy of EPUAPNOT APPLICABLE17 Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermisPartial-thickness skin loss with exposed dermis.

6 The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel. 2016 National Pressure ulcer Advisory Panel | Asked Questions about Pressure Injury Staging2/20/201810 Stage 3 Pressure Injury: Full-thickness skin lossFull-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage or bone is not exposed. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury.

7 2016 National Pressure ulcer Advisory Panel | 3 Pressure Injury with Epibole Epibole (ee-PIB-oh-lee) Rolled edge Due to lack of tissue in the wound bed to support the epidermal cells to cross the wound bed Needs to be removed 2016 National Pressure ulcer Advisory Panel | of Focus20 Frequently Asked Questions about Pressure Injury Staging2/20/201811 Stage 4 Pressure Injury: Full-thickness loss of skin and tissueFull-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer . Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Injury. 2016 National Pressure ulcer Advisory Panel | Pressure Injury: Obscured full-thickness skin and tissue lossFull-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.

8 If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar ( dry, adherent, intact without erythema or fluctuance) on an ischemic limb or the heel(s) should not be softened or removed. 2016 National Pressure ulcer Advisory Panel | Asked Questions about Pressure Injury Staging2/20/201812 Deep Tissue Pressure Injury: Persistent non-blanchable deep red, maroon or purple discolorationIntact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. 2016 National Pressure ulcer Advisory Panel | Tissue Pressure Injury -continuedThe wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss.

9 If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full thickness pressure injury (Unstageable, Stage 3 or Stage 4). Do not use DTPI to describe vascular, traumatic, neuropathic, or dermatologic Asked Questions about Pressure Injury Staging2/20/201813 Evolution of Deep Tissue Pressure Injury Day 1 -Classify intact, discolored skin this pressure as a Deep Tissue Pressure Injury Day 3 -Classify discolored skin with epidermal blistering as a Deep Tissue Pressure Injury Day 10 -If the Deep Tissue Pressure Injury becomes necrotic, classify it as an Unstageable Pressure Injury25 Day 1 -DTPIDay 3 -DTPIDay 10 -UnstageableUsed with permission J BlackNPUAP Pressure Injury StagesAdditional Considerations: Describes anatomic depth that is visible or palpable. Deeper damage possible Does not progress 1-4 Does not heal 4-1. Do NOTD ownstage. Note if caused by a medical device Pressure injuries on mucous membranes should not be staged.

10 Injury does not stage if depth visible/palpable: Stage 1 Stage 2 Stage 3 Stage 4 Depth not visible: Unstageable Deep Tissue Pressure Injury (DTPI)26 Frequently Asked Questions about Pressure Injury Staging2/20/201814 Pressure/Shear at Injury Site?YESNO(or other causes also exist)*Stage 1*Stage 2*Stage 3*Stage 4 Deepest tissue type visible or palpable?YES*Unstageable(obscured by slough or eschar)*Deep Tissue Pressure InjuryNon-Visible(Under non-removable dressing or device---NDNQI / CMS only)NOException:On Mucous Membrane*Mucosal Membrane Pressure Injury(Name, count; but do not stage)Disease: Arterial ulcers Venous ulcers Diabetic Foot ulcersWounds & skin injuries due to:Moisture: MASD IAD Intertriginous dermatitis Trauma: Skin tears MARSI Burns Abrasions BruisesorClassify/stage first. THEN determine if etiology is related to a medical device. Janet Cuddigan, PhD, RN, CWCN, FAAN*See NPUAP staging Device Related Pressure Injuries (MDR PI)28 Medical device related pressure injuries result from the use of devices designed and applied for diagnostic or therapeutic purposes.