Practical Issues in Wound, Skin and Ostomy Management
How will this impact the definition of chronic verses acute wounds? Injury can be considered acute, so will discovery of a pressure injury remain acute until a missed phase in healing or the 30 day window completes?
I did attend the 2016 NPUAP Consensus Conference and thank you for writing about this critical issue. Participants gave consensus only on pre-selected words/sentences. It was not clear to me we would not be allowed to give consensus on entire definitions. It makes no sense we did not have this opportunity. Participants had no input regarding the term “injury” or the development of 2 new pressure categories. In my opinion we did not include significant scientific literature. Also I am distressed because CMS and legal experts should have been consulted prior to announcing any revisions. My concerns were dismissed as I was told the conference was about clinical matters and not legal matters. These revisions seem to be a plaintiff attorney’s dream and are not worth the thousands of dollars and man hours required for implementation. I continue to implore the NPUAP to put these revisions on hold and bring experts together for a true consensus conference.
As a dermatologist and wound care specialist I agree 100% with the new terminology. Why call “ulcer” a discoloration of the skin? Why call ulcer a blister? It is absurd and gives an unprofessional picture with other medical doctors.
Changes in discoloration are macules. A stage 1 pressure injury is a non-blanching red macule, deep tissue injury is a purpuric macule (to me it is merely an eschar that has not dried out but then that is another discussion). A stage 2 pressure related injury is either a blister or an erosion, not an ulcer, and from then on.
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