Diagnosing a pressure ulcer: Barrier to prevention?

• 1/13/2010
• Author: Nurse Scholar
• Category: Nurse Safety Scholar Blog on Pressure Ulcers
• 17585 Views
• 2 Comments
• 

Diagnosing a pressure ulcer: Barrier to prevention?

Correctly diagnosing a pressure ulcer can be complicated. In fact there are times when even the wound care experts are unsure of the etiology of a wound, causing debate over whether or not to refer to a wound as a pressure ulcer. Questions arise when a clear history of the wound is not obtainable, or when wounds over the sacrum and heels appear despite careful attention to using pressure ulcer prevention techniques like repositioning, special mattresses, nutritional support, etc. Are these wounds the result of cardiovascular problems that effect tissue perfusion or obstruction of a blood vessel? Are these wounds an inevitable sign of impending death as is proposed in discussions of Kennedy terminal lesions. At times skin loss that is actually due to incontinence-associated dermatitis as well as a variety of other dermal skin lesions may be wrongly diagnosed as pressure ulcers. Further confusion has arisen as the debates continue regarding the differences between the Category 1 – Stage 1 pressure ulcers versus deep tissue injuries. 

At this point checking for blanching is the diagnostic method for diagnosing Category 1-Stage 1 pressure ulcers. Medical devices that may assist with pressure ulcer diagnosis are not readily available. Some facilities use the skills of the wound specialists to assess all pressure ulcers in an attempt to promote accurate diagnosis as much as is possible with an understanding that there are still so many unanswered questions about cause and effect of pressure ulcers. What are the implications of making the wrong diagnosis? What is the impact on the collection of quality data? Please share your thoughts about this issue with colleagues. I look forward to your comments.

Keep those patients turning.
Irene