National Pressure Ulcer Advisory Panel
At its recent meeting in Chicago, Illinois, the National Pressure Ulcer Advisory Panel (NPUAP) announced a change in terminology regarding pressure ulcers and updated the stages of pressure injury. The term “pressure injury” replaces “pressure ulcer” in the NPUAP Pressure Injury Staging System, according to the NPUAP. The panel stated that the change in terminology more accurately describes pressure injuries to both intact and ulcerated skin. In the previous staging system, “Stage 1” and “deep tissue injury” described injured intact skin, and the other stages described open ulcers. This led to confusion because the definitions for each of the stages referred to the injuries as “pressure ulcers.”
In addition to the change in terminology, Arabic numbers are now used in the names of the stages instead of Roman numerals. The term “suspected” has been removed from the deep tissue injury diagnostic label. Additional pressure injury definitions agreed upon at the meeting included “medical device–related pressure injury” and “mucosal membrane pressure injury.”
The updated staging definitions were presented at a meeting of more than 400 healthcare professionals. Using a consensus format, Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, guided the Staging Task Force and meeting participants to consensus on the updated definitions through an interactive discussion and voting process. During the meeting, the participants also validated the new terminology using photographs.
Pressure injuries are staged to indicate the extent of tissue damage. The stages were revised based on questions received by the NPUAP from clinicians attempting to diagnose and identify the stage of pressure injuries. Schematic artwork for each of the stages of pressure injury was also revised and is available for use at no cost through the NPUAP website: http://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-staging-illustrations.
A pressure injury is defined as localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities, and condition of the soft tissue.
The updated stages are as follows:
- Stage 1 pressure injury: nonblanchable erythema of intact skin
- Stage 2 pressure injury: partial-thickness skin loss with exposed dermis
- Stage 3 pressure injury: full-thickness skin loss
- Stage 4 pressure injury: full-thickness skin and tissue loss
- unstageable pressure injury: obscured full-thickness skin and tissue loss
- deep tissue pressure injury: persistent nonblanchable deep red, maroon, or purple discoloration
Additional pressure injury definitions are as follows:
- medical device–related pressure injury: This describes an etiology. Use the staging system to stage. Medical device–related pressure injuries result from the use of devices designed and applied for diagnostic or therapeutic purposes. The resultant pressure injury generally conforms to the pattern or shape of the device. The injury should be staged using the staging system.
- mucosal membrane pressure injury: Mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury. Because of the anatomy of the tissue, these injuries cannot be staged.
Complete definitions for all stages are available on the NPUAP website at http://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-injury/.
The NPUAP announced more information will be forthcoming on teaching points for the new stages and the rationale for some of the changes in the staging system.