Teaching the Novice to Stage Pressure Injuries

Author: Robert Babiak, RN, BSN, CWON
Poster Number: PI-014
 
Inaccurate identification and staging of a pressure injury (PI) can result in delayed care, poor patient outcomes, decreased reimbursement, and decreased ratings for the provider and agency. Healthcare professionals, including physicians, physician assistants, nurse practitioners, nurses, and therapists, who do not receive training in wound care can have difficulty accurately staging PIs using the definitions from the guidelines by the National Pressure Injury Advisory Panel.¹
 
Pressure injury staging inaccuracies were identified via chart review. The author’s agency developed a test with photographs and descriptions of 33 PIs and wounds to determine competency in identification and staging. The test was administered to registered nurses, licensed vocational nurses, physical therapists, and occupational therapists. The test was administered to all staff hired over the past 4 years, and 248 staff members were tested. Initial and ongoing testing shows that only 10% of the staff can stage and identify PIs correctly 80% of the time with the test administered (mean score < 60%).
 
To assist with identification and staging, an algorithm was developed to ask questions that would guide staff members. The algorithm is used by the health care professional in answering a series of questions as “yes” or “no,” with each answer leading to another question until the professional identifies the stage of the PI. After stage is determined, it is verified by the definitions provided by the National Pressure Injury Advisory Panel.
 
Staff instruction included a review of PI identification and staging. The staff was instructed on how to utilize the algorithm to identify stages of PIs. They were re-tested 2 days later (after instruction period) using a different PI test. Test scores on average increased 19% (mean score > 80%).
 
Per the agency’s 2021 testing results, > 80% of the staff are able to identify 80% of PIs correctly (mean score, > 90%). Accurate PI identification remains an issue with nonspecialized health care providers, as shown by test results of staff hired into the agency. It was concluded that use of the algorithm increased health care professionals’ competency in PI Identification.
 
Reference:
1. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Haesler E, ed. Cambridge Media: 2014.
 
Poster reference:
Babiak R. Teaching the novice to stage pressure injuries. Poster presented at: Symposium on Advanced Wound Care Spring; April 6-10, 2022.