Staging and Risk Assessment ot Pressure Ulcers.
TORONTO -- The first step in good pressure ulcer management is proper assessment, a panel of experts concluded at the annual conference of the Canadian Association of Wound Care.
There is a lot of misuse of assessment tools in the United States, said Diane Krasner, Ph.D.
Each pressure ulcer assessment tool should be used for what it is designed to do, she emphasized. Some are meant for the initial assessment of wounds, while others are meant for assessment of wound healing.
Staging tools for initial assessment include the International Association of Enterostomal Therapy staging system and the National Pressure Ulcer Advisory Panel staging system. Wound healing assessment tools include the Pressure Sore Status Tool and the Pressure Ulcer Scale for Healing.
Ensure that the tool used is specifically designed for the type of wound under examination, advised Dr. Krasner, executive director of the Association for the Advancement of Wound Care and a wound care consultant in Baltimore. For example, clinicians sometimes use the Wagner's classification system, which is specifically designed for diabetic foot ulcers, to assess pressure ulcers. Or they may use pressure-ulcer staging systems to stage skin lesions.
Pressure ulcer risk assessment tools also require careful administration. Many are developed for a particular setting and haven't been tested in other settings, Dr. Krasner said. For example, the Braden scale was developed for acute care, and there are questions about its validity and reliability in long-term care.
If the tools are modified for a particular institution, test for reliability and validity.
It also is important to be careful in interpreting scores. The Braden score for an 85-year-old has a different meaning than the same score for a 46-year-old, said Karen Campbell, R.N., a nurse-practitioner and clinical nurse-specialist at Parkwood Hospital in London, Ont.
Linda Norton, an occupational therapist at West Park Hospital in Toronto, recommends pressure mapping for assessing pressure ulcer risk in patients who are confined to a bed or wheelchair.
Such pressure mapping assessments use a pressure-sensitive mat, which is placed under the patient, on top of his mattress or wheelchair cushion, and gives a visual representation on a computer screen of the pressure distribution under the patient.
Pressure maps can identify surfaces where pressure is not properly distributed. If a pressure ulcer is already present, a pressure map can identify pressure points that may delay healing.
Dr. Krasner suggested following the three C's of-good assessment:
* Comprehensive. Have a plan that includes risk assessment, initial assessment of wounding, and assessment during wound healing. Fully document each assessment.
* Consistent. Perform risk assessment for every patient. If a patient has an ulcer, plan the frequency of wound assessment. Become familiar with the tool being used. If possible, have the same person perform a patient's assessment.
* Consumer-Friendly. Use a simple tool. The Braden scale, for example, is a fabulous tool but it has 13 parameters and is research based, Dr. Krasner said.
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|Author:||IMPERIO, WINNIE ANNE|
|Publication:||Family Practice News|
|Article Type:||Brief Article|
|Date:||Mar 1, 2000|
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