Posts Tagged ‘National Pressure Ulcer Advisory Panel’

Pressure Injuries and Medical Device Dilemmas

Friday, June 16th, 2017

Medical device-related pressure injuries (MDRPIs) are a standard part of wound care, but preventative practices can make a big difference.

Medical Device-Related Pressure Injuries


One of the first things clinicians learn about treating pressure injuries is to find the cause of the pressure and simply remove it. Sounds simple, doesn’t it? But what do you do when the cause of the pressure injury is a medical device which is not only necessary, but literally sustaining a patient’s life?

While some medical device-related pressure injuries are unavoidable, there are things clinicians can do to relieve the pressure and heal the injury. Here’s what you need to know.


What Stage Is It? Test Your Pressure Injury Staging Skills

Thursday, March 24th, 2016

(updated to reflect the 2016 NPUAP Staging Definitions)

How well do you know your guidelines for staging pressure injuries?  View the slideshow and test yourself!

Note: if you have any difficulties opening the slideshow, CLICK HERE to view it in SlideShare.

Test Your Pressure Injury Staging Skills from Wound Care Education Institute



Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see

Improved Pressure Ulcer Care Allows Wound Care Education Institute to Partner with Wisconsin Organizations for Second Time

Wednesday, December 1st, 2010

Wound Care Education Institute

WCEI to Partner with Wisconsin Organizations for Second Time

As a result of a successful collaboration in 2008, Wound Care Education Institute® (WCEI) will again partner with the, Wisconsin Health Care Association, Wisconsin Association of Homes and Services for the Aging and Metastar, in a statewide initiative directed at educating nurses within long-term care facilities in skin and wound management and the prevention and treatment of pressure ulcers (also known as bedsores). The National Pressure Ulcer Advisory Panel defines a pressure ulcer as a localized injury to the skin and/or underlying tissue usually over a bony area, as a result of pressure. This initiative also allows these nurses the opportunity to become certified in wound care as a WCC® (Wound Care Certified).

WCEI will provide wound care training at a reduced price to 200 experienced nurses working in Wisconsin long-term care facilities. Upon successful completion of the training, those nurses become eligible for WCC certification through the National Alliance of Wound Care® (NAWC®). The National Alliance of Wound Care is a nonprofit credentialing board and member association dedicated to the advancement of excellence in wound care through the certification of wound care practitioners in the United States.

“We are excited that the Wisconsin healthcare organizations invited us to continue on the accomplishments of their 2008 initiative to improve patient care. The success of that program has allowed us to expand this initiative to a second phase in 2011”, said Nancy Morgan RN, BSN, WCC, Co-Founder of the Wound Care Education Institute.

Classes and WCC examinations will commence in early 2011. For complete details of the WI Wound Care Initiative, please go to the website,

2011 Classes
Feb 28 – March 4, 2011     March 21-25, 2011
April 18-22, 2011

Madison, WI     Lake Geneva, WI     King, WI

About the Wound Care Education Institute
The mission of the Wound Care Education Institute is to develop multi-disciplinary wound care professionals in the United States by offering educational programs and clinical support, based on up-to-date wound care research, trends, and evidence-based practice. The Wound Care Education Institute offers a comprehensive skin and wound care training program at locations throughout the United States.

Pressure Ulcer Stages (A Review)

Thursday, January 7th, 2010

The following is taken from the National Pressure Ulcer Advisory Panel’s website. As wound care certified professionals, are we all consistently documenting and defining the pressure ulcers correctly. We have included an excerpt from NPUAP’s site below.

The National Pressure Ulcer Advisory Panel has defined the definition of a pressure ulcer and the stages of pressure ulcers, including the original 4 stages and adding 2 stages on deep tissue injury and unstageable pressure ulcers. This work is the culmination of over 5 years of work beginning with the identification of deep tissue injury in 2001.

Pressure Ulcer Definition
A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.

Pressure Ulcer Stages

Suspected Deep Tissue Injury:

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.

Further description:
Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

Stage I:
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Further description:
The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk)

Stage II:
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

Further description:
Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
*Bruising indicates suspected deep tissue injury

Stage III:
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. May include undermining and tunneling.

Further description:
The depth of a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible or directly palpable.

Stage IV:
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Further description:
The depth of a stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable.

Full thickness 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.

Further description:

Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.

For more information about Pressure Ulcers and Staging and how to become Wound Care Certified, please visit our registration page.

Prevention, Prevention, Prevention

Wednesday, October 28th, 2009
Turning and Repositioning

Turning and Repositioning

To most of us in the Health Care industry, nursing in particular, it is obvious that the best ways to heal wounds is to prevent them in the first place. Sometimes however, that is not so obvious to members of the health care team that care for our patients both young and old and in-between. There are many reasons that can be attributed to that ignorance but that is not the reason for this post. That ignorance can be addressed through further education.

Lets discuss prevention of ulcers and wounds. Assessment of our patients needs is one way to initiate preventative measures. I was reading an article and commentary on Catherine Ratliff, Ph.D., from a meeting at the National Pressure Ulcer Advisory Panel in Arlington, VA

She recommended that caregivers assess four factors to determine an individual’s risk for heel pressure ulcers: age older than 70 years, diagnosis of diabetes, decreased mental status, and lack of movement in the legs and feet. Also, consider whether individuals are ambulatory, walk with assistance, or are confined to bed, she said.

Caregivers should take some precautions to prevent heel pressure ulcers even in individuals who are at low risk, Dr. Ratliff said. Check the circulation in the affected area, check whether the skin is warm or cool to the touch, examine the feet for redness, and apply moisturizer to the heels. Encourage individuals to get out of bed at least three times a day if possible. If that doesn’t happen, consider a pressure-redistributing mattress.

Individuals who are at higher risk, or those who already have a heel pressure ulcer, require stricter interventions, she said. Assess the patient and apply moisturizers more often, work hard to get the individual mobile, and perhaps use devices that take pressure off the heels.

You can read the rest of the article here .

What else can we do to assist preventing wounds from developing on our patients? As Wound Care Certified professionals, we can educate the public before and after they become our patients. Writing articles and submitting them to the web via blogs, making videos that speaks to our knowledge about prevention of wounds is an area that we can improve upon. Diabetic screening and education can be another example of how we can possible prevent development of ulcerations. For example we could do more foot examinations as part of a community outreach. All individuals with diabetes should receive an annual foot examination to identify high-risk foot conditions. This examination should include assessment of protective sensation, foot structure and biomechanics, vascular status, and skin integrity. People with one or more high-risk foot conditions should be evaluated more frequently for the development of additional risk factors. People with neuropathy should have a visual inspection of their feet at every visit with a health care professional.

Skin and Wound Manual

Skin and Wound Manual

A great resource for any Wound Care or Health Care Provider is the Skin and Wound Resource Manual Use the resources that are available to you. Teach the people you care for to take care of themselves before and when they develop wounds. Prevention of the wound prior to it develops is the best way to heal it!

For more information about becoming Wound Care Certified, please visit

Wound Care Seminar (WOW 2009 Pt 2)

Wednesday, May 13th, 2009


Yesterday was a preview of  September 10, 2009 and the Pre-Conference Sessions for this year’s Wild on Wounds Conference. Below are some descriptions of the sessions for Friday September 11, 2009. We have some awesome speakers and interesting sessions lined up for you so check them out and get ready for Las Vegas!!!

  • Opening Session – Keynote
    David Crowe

    Go “ALL IN” on this one as it is a Sure Bet for a Full
    House as we practice our laughter skills with comedian
    David Crowe. David is the only comedian in history to
    have won both the Seattle and San Francisco International
    Stand-up Comedy Competitions. He won them back-toback,
    within nine months of each other. He spends most
    of his time on the road, headlining the best comedy clubs
    around the United States, Canada and Europe. He recently
    debuted his own one-hour special on ShowTime®, has
    appeared numerous times on Comedy Central® and is a
    favorite on the “Bob and Tom Show” which is syndicated to
    120 markets nationwide. In 1996 he was selected to open
    for President Bill Clinton at the Paramount Theater in Seattle.
  • The Buzz Report
    Nancy Morgan, RN, BSN, MBA, ET, CWCN, WCC
    Donna Sardina, RN, MHA, WCC

    This is your source for the latest breaking wound care
    news: What’s new! What’s now! What’s coming up! Donna
    and Nancy, WCEI co-founders, will bring you up to date
    on all things buzzable in wound care – new products,
    guidelines, resources and tools.
  • NPUAP Update 2009
    Diane Langemo, PhD, RN, FAAN, NPUAP President

    A detailed overview of the recent and upcoming accomplishments of the National Pressure Ulcer Advisory Panel will be
    presented in this session. This will include information on the Shear Initiative: the NPUAP-EPUAP International Pressure
    Ulcer Prevention and Treatment Guidelines, including highlights from the new sections in the guidelines (palliative care, pain,
    critical care) and NPUAP’s ongoing work with the CMS in the area of public policy related to pressure ulcer preventions, care
    and research. There will be time for an interactive audience question and answer period.
  • Principles & Practice of Maggot Debridement Therapy Part 1
    Ron Sherman, MD, MSc, DTM&H, Asst. Researcher University of California, Irvine, California
    Pam Mitchell

    Back by popular demand! Welcome back, Dr. Sherman!!! Taught in two sessions, you’ll get the didactic and the practical
    hands on. Learn about the history, biology, indications and contraindications for maggot therapy. Then put all that to use
    when you actually learn the technical aspects of maggot debridement therapy by applying live maggot dressings to mock
    wounds. Seats are limited! Sign up now!
  • Wheelchair Boot Camp
    Bill Richlen, PT, WCC, CWS Infinitus, LLC, WCEI Instructor

    When a patient is sitting, the ischial tuberosities are under great pressure forces of around 100 mmHg, making them one of the
    most common areas of pressure ulcer development. Due to improper positioning, the sacrum/coccyx and plantar aspect of the
    foot also become high risk areas. In this session we will discuss the common problems seen in seating, consider the postural concerns
    for the spine and pelvis, and demonstrate how to choose the appropriate cushions and properly fit wheelchairs for your patients.
  • The Diagnostic Basis of Wound Healing: The Lab and Beyond . . .
    Don Wollheim, MD, WCC, FAPWCA, IMPLEXUS Wound Care Service, LLC, WCEI Instructor

    Whether faced with diagnostic uncertainty, stalled wound healing or baseline assessment, utilizing scientific investigation can
    help uncover and identify underlying problems that are complicating wound healing. This session will include a comprehensive
    review of diagnostic tests and laboratory values that are critical for assessment and monitoring of wound and skin therapy.
  • Principles & Practice of Maggot Debridement Therapy Part 2
    Ron Sherman, MD, MSc, DTM&H, Asst. Researcher University of California, Irvine, California
    Pam Mitchell

    Back by popular demand! Welcome back, Dr. Sherman!!! Taught in two sessions, you’ll get the didactic and the practical
    hands on. Learn about the history, biology, indications and contraindications for maggot therapy. Then put all that to use
    when you actually learn the technical aspects of maggot debridement therapy by applying live maggot dressings to mock
    wounds. Seats are limited! Sign up now!
  • Palliative Care Practices for Wounds at End of Life
    Linda M. Hoplamazian, RN, BSN, MHA, WCC

    Wound care professionals can manage wounds at end of life by utilizing evidence-based standards from best practice for
    individualized care delivery. The challenge: Choosing the most effective approach to wound care while meeting the goals for
    providing quality palliative symptom management to the patient approaching end of life. Standardized practice guidelines will be
    presented for management of pressure ulcers and other types of common wounds seen at end of life.
  • If It Wasn’t Documented, It Wasn’t Done! Documentation Woes
    Cindy Broadus, RN, BSHA, LNHA, CLNC, CLNI, CHCRM, WCC, 3C Healthcare Consulting, LLC, WCEI Instructor

    The medical record is considered to be the most reliable source for determining what happened. It is a legal document, yet
    not always treated as such. With litigation lurking around the corner for every healthcare professional, we, as Wound Care
    Certified professionals, need to make sure our documentation is complete, concise and correct. Come on it and let’s talk
    about correct terms, techniques, and steps it will take to keep you out of trouble.

For those of you interested in becoming wound care certified, come to the Wild on Wounds Seminar in Las Vegas and learn from some these outstanding speakers. For details about becoming wound care certified go to

We have some great sessions and a lot to learn. Come out to Las Vegas and meet up with your colleagues to learn about all of these great topics. Register Here.