National Pressure Ulcer Advisory Panel Changes Terminology in Pressure Ulcer

On April 13, 2016, a release from the National Pressure Ulcer Advisory Panel (NPUAP) stated that the term “pressure injury” replaces “pressure ulcer” in the NPUAP injury staging system. According to the report, a change in terminology more accurately describes pressure injuries to both intact and ulcerated skin. It was concluded that the previous staging system was confusing. A Stage I and Deep Tissue Injury described injured intact skin, while the other stages describe open wounds or ulcers.

In another change in terminology, the panel is now using Arabic numbers instead of Roman numerals in the names of stages.

A meeting of over 400 professionals was held in Chicago on April 8-9, 2016. Using what was called the consensus format, Dr. Mikel Gray of the University of Virginia guided the Staging Task Force.

Pressure injuries are staged to indicate the extent of tissue damage to the skin. These pressure injuries, as they are now described, occur most frequently to the elderly, the infirm and handicapped who are confined to sitting or lying for long periods of time. Many of these pressure injuries are found in nursing homes, long-term facilities and assisted living facilities around Illinois and the country.  These injuries also occur frequently in hospitals.

Pressure injuries can be prevented by staff that is persistent in physically moving a resident or patient and making sure that circulation is sufficient to allow blood flow to all parts of the extremities of the body. If a person is lying or sitting on an area of the body that is close to a bone, pressure injuries are more likely to appear.

According to this announcement, the staging process still runs from Stage I through Stage IV. A Stage I pressure injury is a non-blanchable erythema of intact skin. To identify a Stage I pressure injury, the skin might appear differently and darkly pigmented skin or maybe changes in sensation, temperature or firmness in the area. Color changes do not include purple or maroon discoloration.

Stage II pressure injuries is a partial-thickness skin loss with exposed skin.  These injuries are most commonly found in the skin over the pelvis and heel. This stage should not be used to describe moisture associated skin damage, including incontinence associated, dermatitis or traumatic wounds.

Stage III pressure injuries is a full-thickness skin loss. The depth of tissue damage varies by location.  There may be slough or eschars observable.

Stage IV is a full thickness skin and tissue loss category which show exposed muscle, tendon, ligament, cartilage or bone in the ulcer.

The comments in this announcement also describe unstageable pressure injuries and deep tissue pressure injuries. There is also additional definitions of pressure injuries that include medical device related pressure injuries and mucus membrane injuries.

The organization indicates that there will be more information forthcoming on teaching points for the new stages and the rationale for some of the changes in the staging system.

Kreisman Law Offices has been handling nursing home abuse cases, nursing home negligence cases, nursing home injury cases, nursing home pressure sore injury cases, pressure ulcer cases and medical negligence cases for individuals and families who have been injured or killed by the negligence of a medical provider for more than 40 years, in and around Chicago, Cook County and its surrounding areas, including Zion, Lake Bluff, Gurnee, Grayslake, Round Lake Beach, South Chicago Heights, Blue Island, River Grove, Clarendon Hills, Morton Grove, Des Plaines, Niles, Richton Park, Chicago (Bridgeport, Canaryville, East Side, South Loop, West Town, Lincoln Park, Gold Coast), New Lenox and Lincolnwood, Ill.

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