Wound Care Today

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In each issue of Wound Care Today we investigate a hot topic in wound care.
Here, Binkie Mais asks...
Some conditions or incidents
receive such a level of notoriety
in health care that they become
regarded as indicators of poor care in
themselves; falls or urine infections,
for example; or in this case, pressure
ulcers. So avoidable are pressure
ulcers deemed to be that schemes
such as the NHS Safety Thermometer
list them as key indicators of poor
care ), which
is a useful step forward of course,
How can we get a universally accepted
pressure ulcer staging system?
but is predicated on staff recognising
what a pressure ulcer is in the first
place. Traditionally, pressure ulcers
have been assessed and classified
using a variety of grading systems,
but a new set of guidance has raised
the question of whether pressure
ulcer grading has now become
too complicated.
MAKING THE GRADE
Grading or staging of pressure
ulcers has continued to evolve over
the past decades — for example,
back in 1983, the Torrance Scale
was introduced, and then in 1994
there was the Scottish Pressure Sore
Severity Scales (Reid and Morrison,
1994). But, having different systems
available makes reaching consensus
of pressure ulcer severity difficult and
any data collected only has relevance
at a neighbourhood rather than
national level (Beldon, 2014).
In 2003, the European Pressure
Ulcer Advisory Panel (EPUAP) took
the ‘bull by the horns’ and produced
a standardised grading system
on pressure ulcer classification,
which was subsequently updated
in 2009 in collaboration with the
National Pressure Ulcer Advisory
Panel (NPUAP), and again in 2015
in association with the Pan Pacific
Pressure Injury Alliance (EPUAP/
NPUAP/PPPIA, 2014).
With pressure ulcers presenting
as a wide range of wounds, from
mild discoloration over intact skin to
a large open cavity wound affecting
all tissue layers, even the bone, there
is surely no question around the
need to have a tool with which to
systematically identify and
stage them.
Pressure damage also seems to
continually remain in the limelight
and under scrutiny (‘Pensioner who
was found sobbing in her wheelchair
dies from infected bed sores after
being left for 4 hours without foot
support’— Daily Mail, 2 September
2016). There is no doubt as to its cost,
both in economic and human terms,
4 WOUND CARE TODAY 2016,Vol 3, No 1
WOUND WATCH i
The level of scrutiny in relation to the development of pressure ulcers requires a consistent
approach to staging. The NHS expects us to be able to compare pressure ulcer prevalence and so
accurate staging of pressure ulcers is essential. A different interpretation of the staging system
can lead to inconsistency in reporting and ultimately investigating.
Thus, the issue of staging pressure ulcers is one that will impact clinically as well as
financially. The stage of ulcer will influence not only clinical care delivery, but also the
investigation process and potentially a financial penalty for the development of an avoidable
pressure ulcer.
Consistency is key and the NHS needs to agree on the adoption of the latest staging
recommendations and education to support the classifications needs to be essential or mandatory
training for all clinical staff who required to stage pressure ulcers.
Jackie Stephen-Haynes
Professor in tissue viability, Professional Development Unit, Birmingham City University and consultant nurse,
Worcestershire Health and Care NHS Trust