Bariatric Times - December 2008 - (Page 9)

Bariatric Times • December 2008 Patient Management Perspective 9 WHAT IS AN ACCEPTABLE STANDARD OF PRESSURE ULCER CARE? The Agency for Health Care Quality and Research (AHQR), National Pressure Ulcer Advisory Panel (NPUAP), Wound Ostomy, Continence Nurses Association (WOCN), Association for Advanced Wound Care (AAWC), and others have established best practice models addressing concerns of pressure ulcers. By definition, a pressure ulcer is a direct result of pressure, friction or shear. Some factors contributing to pressure ulcers include moisture, dehydration, malnutrition, and immobility. Pressure ulcers typically occur over a bony prominence and develop because of the inability to adequately reposition the patient from that area, thus creating damage to underlying tissue. Staging pressure ulcers is an important aspect of assessment. The pressure ulcer staging system widely used for several decades was initially described by Shea in 1975 and was based on tissue loss and depth of destruction.10 The original definitions were thought to be confusing to many clinicians and led to inaccurate staging of ulcers, especially those due to perineal dermatitis or deep tissue injury. The NPUAP has 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. Stage I pressure ulcers are described as intact skin with nonblanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; however, its color may differ from the surrounding area. Stage II is partial-thickness loss of dermis presenting as a shallow, open ulcer with a red or pink wound bed, without slough. It may also present as an intact or open/ruptured, serum-filled blister. Stage III refers to 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. It may include undermining and tunneling. Stage IV is fullthickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed, often including undermining and tunneling. In addition to revisions to Stages I through IV, unstageable and suspected deep tissue injury were added. An ulcer is considered unstageable when it exhibits fullthickness 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. By definition, suspected deep tissue injury is a 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.2 To learn more about assessment parameters, consult the additional reference list provided in Table 1. A recommended treatment program incorporates assessment of the patient and the pressure ulcer, tissue load management, local ulcer To meet CMS policy, the International Expert Wound Care Advisory Panel identified several points on which to address pressure ulcer prevention: • patient education • clinical training • strategies in developing communication and terminology materials • toolkits and protocols • behavioral challenges • provider adherence • patient adherence. To learn more about the Advisory Panel, see Table 1: More Reading. Creating Standardized Orders—Hot Tips! • Keep the project achievable with specific, attainable tasks • Seek evidence-based, informed data to support treatment • Recognize clinical champions/ stakeholders • Make provision for follow-up • Report successes • Understand the value of communication.

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Bariatric Times - December 2008 Table of Contents Patient Management Perspective Diabetes Perspective Interview: ASMBS’s Georgeann Mallory Editorial Message Editorial Board Body Contouring Perspective Meeting Perspective Journal Watch Advertiser Index News & Trends

Bariatric Times - December 2008

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