For more than 20 years the National Pressure Ulcer Advisory Panel (NPUAP) has provided leadership in major topics surrounding pressure ulcers, including standardization of the staging system and introducing useful additional classifications of Unstageable and Deep Tissue Injury. However, recent changes on their website show new nomenclature that, in my opinion, risks introducing confusion for caregivers and policy makers.

Jeff Levine, Jeffrey Levine MD geriatrician physician artist photographerIt looks like NPUAP is adding the term “CATEGORY” to “STAGE.”  The explanation for the term CATEGORY is found within the document entitled “Pressure Ulcer Prevention: Quick Reference Guide.”  The reason is that STAGE infers that pressure ulcers go through an hierarchical progression from 1 to 4, which they often do not.  This is indeed a great teaching point, however, does this deserve revision of textbooks, training manuals, and assessment forms to add new syllables to our wound care vocabulary? In my recollection, the term CATEGORY was applied to grading the strength of hurricanes, not the severity of pressure sores.

I have been on the front lines of wound care and education in hospitals and nursing homes for the past two decades, and it is challenging to teach staging, perform quality control, and insure proper transmission of information across the healthcare continuum. Altering the tried-and-true basics of taxonomy is an exercise that may distract from the tasks already at hand.

Pressure ulcers generally occur only on persons who are seriously ill. In these patients every second counts, and documentation of wound assessment and treatment is critical. Spending time on additional vocabulary discussions with peers, families, and patients seems counterproductive.

There are certainly huge issues for NPUAP to tackle other than nomenclature revisions. Here are some of them:

• The risk-management crisis and the epidemic of lawsuits that pressure ulcers generate, and the stresses that staff face as a result.

• Implications of classification of most wound care treatments as “devices” by the FDA, with lack of data regarding efficacy. This leads directly to lack of evidence-based decision-making with regard to treatment decisions.

• Rolling back the heavy industry influence on wound treatment algorithms – something that the medical profession is just getting their arms around in the pharmaceutical arena.

So please, let’s return to our jobs to prevent and heal pressure ulcers, which includes education of staff along with proper and timely wound assessment and documentation, and stay away from lexicographical debates on staging terminology.  The current staging system is embedded within our system and works fine, thanks largely to prior NPUAP initiatives.  Pressure ulcers and patients that get them are complex enough, and I would prefer not wearing heavy rain-gear when called to make wound rounds.

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To view all my blog posts on wound care click here.

Related post: Pressure Ulcer Nomenclature and Documentation.

For info on my Pocket Guide to Pressure Ulcer Staging click here.

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