Posts Tagged ‘Pressure Ulcers’

Great Expectations Unmet: The Real Reason Patients Sue

Friday, August 5th, 2016

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Most lawsuits start not because of poor medical care but because families believe promises were made and broken and they are angry.


Great Expectations Unmet: The Real Reason Patients Sue


If you speak to any health care attorney about the proliferation of lawsuits against hospitals, nursing homes, and health care providers (HCPs) over the last decade or so, you will engage in a conversation peppered with a variety of legal terms. These may include breach of duty, negligence, malpractice, wrongful death, statutory standard of care, or even criminal culpability. It is important to understand that these are formal words with specific legal meanings, and at least a few of them appear on every plaintiff complaint as the reason for the lawsuit.

This is in sharp contrast to every deposition I have ever read from a plaintiff—usually the surviving spouse or child/children of the deceased. These family members never use legal jargon. Instead, they use emotional terms that reveal the true reason they are suing. Unless the family member works in the medical field, they rarely criticize the actual medical care but rather express great sadness with the personal care and the way they were treated. Plaintiffs frequently remark about the lack of caring they felt in health care. It is these words that we must focus on if we are to understand the patient perspective and thereby improve patient satisfaction.


Pressure Injuries? (Don’t) Say It Ain’t So!

Tuesday, April 19th, 2016

Mounting pressure to call pressure injuries (aka pressure ulcers) something else has caused a stir – and clinicians in wound care are feeling the heat. Find out why.

Pressury Injuries - Don't Say It Ain't So

One of the most basic principles of healing a wound is to determine the cause – and then remove it. It sounds so simple, doesn’t it? But this is easier said than done, as many wounds have similar characteristics, and we don’t always have all the facts at our disposal in order to pinpoint the cause.

Unfortunately, this process has become further – and unnecessarily – complicated, thanks to increasing pressure (no pun intended) on wound clinicians to name a pressure injury something else. See? We told you it was complicated. 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

How do I stage a wound if cartilage is present?

Monday, November 17th, 2014

(For the latest information based on the 2016 National Pressure Ulcer Advisory Panel Staging System, visit the 9/16/16 blog, “Pressure Injuries with Cartilage? Stage Away”)

In the human body the cartilage is found in joints, rib cage, ear, nose, bronchial tubes and between the inter-vertebral discs.

As wound clinicians we most often see Printcartilage just below the bridge of the nose or on the ear in our patients with pressure injuries.

Many clinicians continually question themselves how to stage a wound with visible or palpable cartilage present.

After all, cartilage does serve the same function as bone, but the word “cartilage” itself is not found in the stage IV definition from the National Pressure Ulcer Advisory Panel, or NPUAP. 

So how do you stage the pressure injury with visible or palpable cartilage?

Here is your answer: In August 2012, the NPUAP released a statement that stated: “Although the presence of visible or palpable cartilage at the base of a pressure injury was not included in the stage IV terminology; it is the opinion of the NPUAP that cartilage serves the same anatomical function as bone. Therefore, pressure injuries that have exposed cartilage should be classified as a stage IV.”

What that means is any pressure injury where you can see or feel cartilage will be classified as a stage IV pressure injury.

Simply put: if you have cartilage present in the wound, you stage it as a stage IV pressure injury.

Take our webinar, Staging and Identifying Pressure Injuries, or browse through all our webinars.  Use Coupon Code: BLOG.

I Stage, II Stage, III Stage , IV…. Making Pressure Ulcer Staging a Little Easier

Friday, June 6th, 2014

There has to be a way to get everyone on the same page.  You would think that over the last 6-7 years since the National Pressure Ulcer Advisory Panel (NPUAP) had released the updated staging guidelines we would have gotten better at this.  Not necessarily the case. blog
Lets try to make pressure ulcer staging as simple as possible.  We will take out the all the extra verbiage; you can read that later on.  We will break staging down to some user-friendly terms.  Now remember, we are talking about pressure ulcers, so all of these skin injuries pressure had to be present, sure – friction and shearing can contribute, but pressure must be present. They are usually located over a bony prominence but we know they don’t have to be; they will be located anywhere the skin has had unrelieved pressure.  If they are related to a device they will take on the shape of the device that has caused the injury to the skin.

Stage I.  This is an area of non-blanchable area of erythema (redness) of intact skin.  That’s what it is. Period.  Intact red skin.  Non-blanchable is when we push on the skin it stays red; it doesn’t turn white or blanch.  So, intact, non-blanchable area of erythema, a stage I pressure ulcer.

Stage II.  This is a superficial or shallow open area.  We say it is pink, partial and painful.  The damage is into the dermis here so the tissue we see will always be smooth pink/dark pink, not granulation tissue.  Never will we see any necrotic tissue here; your wound won’t have yellow, black brown colors in it.  It also may be an intact serum (clear fluid) blister. So there you have it; a stage II is a superficial open area with NO necrotic tissue or it can be an intact or ruptured serum filled blister.

Stage III. This stage is easy.  Damage is now into the subcutaneous tissue, but not through the subcutaneous layer.  So this is the start of full thickness tissue injury.  Now here is where we can start see slough, eschar, and granulation tissue in the wound bed.  Tunneling and undermining may also be present in the full thickness pressure ulcer.  In the stage III pressure ulcer we may see healthy subcutaneous tissue, necrotic tissue or granulation tissue.  What we WON’T see in the stage III is muscle, tendon, ligament or bone, ever.

Stage IV.  This is full thickness tissue damage where we now see muscle, tendon, ligament, or bone in the wound bed.  The definition also states “palpable” so if we can feel tendon or bone here, we would stage it as a stage IV.   Cartilage in the wound bed would be included in the stage IV pressure ulcer.  We can have granulation tissue or necrotic tissue present in the wound bed as well.  Undermining and tunneling may be present in a stage IV, but what I MUST see or feel are those underlying structures – muscle, tendon, ligament and / or bone present to say it’s a “stage IV”.

Unstageable pressure ulcer is a stage we use to classify the pressure ulcer that has enough necrotic tissue present to make the clinician uncertain whether the pressure ulcer is a stage III or stage IV.  So until enough necrotic tissue can be removed we place it in the “unstageable” category.  Once that necrotic tissue is removed and we can evaluate the actual level of tissue destruction in the wound bed, that is when we will stage it and it will either be a stage III or a stage IV.

Suspected Deep Tissue Injury (SDTI).  To be a SDTI the skin must be intact, it must be purple or maroon in color or an INTACT BLOOD filled blister.  Once this intact SDTI pressure ulcer opens up, we would then reclassify it based on our assessment or tissue type in the wound bed.

We need to use the staging definitions set out by the National Pressure Ulcer Advisory Panel (NPUAP) correctly, and all clinicians who assess skin need to have a good understanding of these definitions in order to properly stage pressure ulcers.  What was discussed about above is just a summary, there is more reading we need to do, but this will give us a good place to start with the staging.  We need to start staging consistently across the healthcare continuum; it really just comes down to good wound assessment skills, knowing the tissue type that lies before your eyes and identifying the level of tissue destruction and applying them to the NPUAP staging definitions. Lets get this right!

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.

Microcyn Skin and Wound Cleanser

Sunday, October 17th, 2010

Microcyn Skin and Wound Cleanser
Oculus Innovative Sciences

Description: Microcyn Wound Care is designed to clean, assist with debriding and moisten a wide spectrum of acute and chronic wounds without harming healthy tissue. Microcyn® is available by prescription only.

Actions: Effective in cleaning biofilms: removes proteins and organic loads from wound bed.  Rapid activity against a broad spectrum of gram-positive, gram-negative and yeast species including MRSA and VRE with the  in vitro time kill of 30 seconds.

Indications: Acute and chronic dermal lesions, Stage I-IV pressure ulcers, Stasis ulcers, Diabetic ulcers, Post-surgical wounds, Abrasions and Minor irritations of the skin.


  • No known drug/treatment interactions or contraindications
  • No rinsing required: can be used directly on the wound or in combination with gauze and other absorbent wound dressings
  • Non-irritating: safe to use around the nose, mouth and eyes
  • Ready to use: no mixing, dilution or rinsing necessary
  • Compatible: can be safely and effectively used prior to treatment with silver dressings, skin substitutes, growth factors, negative-pressure therapy and others wound care treatments
  • Stable: 18 to 24 months depending on bottle type


Wound Photos Resource

Tuesday, August 17th, 2010

Wound Central

As Wound Care Certified professionals, one of our responsibilities is to educate our patients and peers as well as staying informed. In a series of upcoming blog posts, Wound Care Resources Series, we will be sharing information about available resources to our Wound Care Certified and Health Care provider community.

Today we will be sharing information about a Wound Photo CD Resource that is available through This CD is filled with various images of wounds and skin conditions for use in educational and training programs. On this CD you will find images of pressure ulcers, lesions, venous and arterial wounds, diabetic wounds and close up pictures of tissue types. This CD is a great for adding visual reinforcement to you educational activities.

The Wound Photo CD has over 150 photographic images in high quality JPEG Format. All images can be downloaded into other programs or printed. This is perfect for Powerpoint Presentations.

Image Categories include:

  • Skin Lesions
  • Lower Extremity Wounds
  • Tissue Types
  • Surgical Wounds
  • Tissue Types
  • Other Wounds
  • Miscellaneous

You can find more information about this Wound Photo CD or purchase this resource at

For more information about becoming Wound Care Certified and our Skin and Wound Management Course, please visit

Prevention of Skin Breakdown

Friday, August 6th, 2010

The Wild on Wounds National Convention is coming up  September 23-25, 2010 in Las Vegas. Continuing in our session highlights, Prevention of Skin Breakdown will be presented by Scott Batie M.Ed, M.P.T., WCC, Scott Batie Consulting, WCEI Instructor

Prevention is the Key! Based upon the 2009 International Pressure Ulcer Guidelines, evidence based care and AHRQ clinical practice guidelines, this one hour session will give you everything you need to succeed. Take this information back to your team and teach them how to prevent pressure ulcers, diabetic, venous and arterial ulcers, as well as moisture related skin breakdown.

For more information about the Wild on Wound National Conference or to register, please check out

For more information about the Wound Care Education Institute and their Skin and Wound Management Course, please visit

Pressure Relief Modalities for Wound Care- Exoskeletons?

Thursday, July 15th, 2010

Pressure Relief Modalities for Wound Care are topics of concern that every wound care certified clinician must consider in their treatment plans for their patients. Some of the common pressure relieving devices include gel pads or cushions, position devices, low air loss and alternating pressure mattresses. Today, I caught a glimpse of what may help some patients in their fight against pressure ulcers on some parts of their bodies due to immobility and consistent pressure to certain parts of the body.

Rex the Robotic Exoskeleton may sound like something out of the future, but I assure you the future has arrived. Check out the video below. From a wound care clinician’s perspective, I immediately was intrigued by what I saw in terms of what the future may hold for pressure relief, mobility management and treatment for patients that suffer from chronic pressure ulcers and wounds.

Some of the immediate benefits that came to mind include but are not limited to:

  • Pressure Relief to the sacral and ischial areas
  • Improved circulation through mobility
  • Decreased atrophy
  • Improved Dignity

So what are your thoughts on this type of technology and what it may mean to the treatment of patients with wounds? I know costs would be a concern, but we should consider the costs of long term wound care treatments and how technology advancements like the Rex Robotic Exoskeleton would mean. It appears that the quality of life for the young man in the video was considerably enhanced. What say you?

For more information about the Wound Care Education Institute or to become Wound Care Certified, please visit