An Overview of Tissue Types in Pressure Ulcers: A Consensus Panel Recommendation

author: 

Joyce Black, PhD, RN, CPSN, CWCN, FAPWCA; Mona Baharestani, MD, PhD, ANP, CWON, CWS; Steven Black, MD, FACS; Jamie Cavazos, RN, MSN, CWOCN; Teresa Conner-Kerr, PhD, PT, FACCWS, CWS, CLT; Laura Edsberg, PhD; Benjamin Peirce, RN, CWOCN, COS-C; Evelyn Rivera, RN, CWOCN; and Greg Schultz, PhD

 

Abstract: Pressure ulcer assessment is usually performed at the bedside by a clinician with minimal training in wound assessment. A multidisciplinary panel of United States’ wound experts was assembled to provide anatomically accurate and practical terms associated with pressure ulcer assessment, healing, and nonhealing in order to help clinicians identify and describe tissue types and pressure ulcer stages. Specifically, anatomical markers and/or structures within the wound are described to facilitate tissue type identification and pressure ulcer staging. The panel agreed that the provision of a common language facilitates quality care across settings. Although some research has been conducted, additional studies to determine the validity and reliability of wound assessment and healing terms and definitions, as well as pressure ulcer staging systems, are needed.

Accurate physical and psychosocial assessment is imperative to determine an appropriate plan of care for the patient with a pressure ulcer.¹ Chronic wounds occur in 2.8 million people in the US and cost billions of dollars to treat.² However, Patel and Granick³ examined 50 medical school curricula and found that medical students receive an average of only 4 hours of instruction on wound-related topics (including anatomy and physiology of wounds and wound healing) during their entire medical school training. Nurses receive similar minimal training. Vogelpohl and Dougherty⁴ reviewed 10 nursing textbooks and reported that on average only 200 lines of text and 10 tables were presented on wounds, some of which were inaccurate. Many nurses learn human anatomy using only textbook descriptions and pictures and lack a thorough knowledge of the appearance of human tissues in either a cadaver or surgical specimen. The lack of wound and pressure ulcer training also has an impact on practice. Subsequent inaccurate assessments of ulcer size, stage, and visible tissues may affect payment and processes of care needed to support healing can be developed in error. At times, these inaccuracies can lead to fines and litigation. read more...