Heyl Royster

Updates to the NPUAP’s Pressure Injury Staging System: Why They Do Not "Wound" Providers

By: Michael Denning

The National Pressure Ulcer Advisory Panel (NPUAP) has recently updated its Pressure Injury Staging System to include modified definitions of certain terms and to provide a clarifying staging system to better address the different types of skin wounds commonly seen by medical professionals. The Panel elected to make these changes to avoid future confusion regarding the distinction between intact and ulcerated skin. The most significant updates include replacing the term “pressure ulcer” with the term “pressure injury” and altering the staging characterizations from the previous Roman numeral designations to an Arabic number classification. Additionally, the word “suspected” has been removed from the Deep Tissue Injury diagnostic label and the use of the term “pressure injury” has been incorporated into the definitions for Medical Device Related Pressure Injury and Mucosal Membrane Pressure Injury.

It is important that providers of pressure injury treatment take note of these recent changes and incorporate the new terminology and staging system into their diagnoses and treatment moving forward. Specifically, we would advise that our clients familiarize themselves with the updated stages and diagnose all new and pre-existing wounds using the Arabic number classification. Furthermore, we would recommend that all staff integrate these changes into their patient charts and any facility specific wound documentation, such as a Long Term Care Minimum Data Set.

We anticipate that those who fail to take proactive measures to instill these new terms and staging designations may face legal consequences. The pressure injury staging system serves as an indicator of the extent of tissue damage to a patient’s wounds. Reliance on the former terms and stages may result in an uncomfortable line of questioning at a deposition, or worse, at trial, if the party’s wound care was to become the subject of a civil proceeding. This line of questioning may be avoided if each patient’s wounds are assessed and staged using the new system, a treatment care plan is put in place to address the assessed tissue damage, and all staff consistently document the administering of the recommended treatment. Proper wound classification contained within the patient’s chart will permit a party to use the patient’s treatment records as evidence of the severity of the patient’s wounds over time. This evidence coupled with documented proof of the administering of the recommended wound care treatment will permit any party to present a high-quality defense to any pressure injury lawsuits that may arise.

The updated definitions and the new staging system offer a much needed clarification for medical professionals who are regularly being called to diagnose and classify a patient’s wounds. They are available on the NPUAP website. If you have any questions or would like to discuss this issue further, please contact Michael Denning or Jessica Klaus.

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