Pressure ulcer or moisture lesion-lets get it right: Introducing the pug tool
Judith A Barnard
Northern Lincolnshire and Goole NHS Foundation Trust, England
: J Regen Med
Abstract
Statement of the problem: Approximately 120 pressure ulcer referrals a month are reported requiring verification. It was apparent that the healthcare professionals assessing these patients were finding it difficult to correctly identify skin damage. The classification skills of healthcare professionals assessing these patients were problematic. Their identification of the type of ulcer they were looking at was unreliable. Many of the nursing staff within the trust were unable to distinguish between various pressure ulcer stages and differentiating superficial pressure ulcers from moisture lesions, this often leads to inaccurate reporting and inappropriate management. Utilising the European Pressure Ulcer classification guidance in 2014 an easy to use image illustrated decision-making tool was designed. The laminated double-sided wheel refers to pressure ulcers on one side and side two refers to moisture lesions, suspected deep tissue and unstageable. A logo used on the tool was developed from the Pressure Ulcer Guide, which includes PUG, the Pug dog has now become an insignia. In the months from October–December 2015 an estimated 73% of pressure ulcers referred were miss-classified since the introduction of the PUG tool a recent audit estimated 80% of skin damage is now being classified correctly. In this short period of time, the classification skills among healthcare professionals have improved resulting in more accurate reporting. By the end of the session, the audience will be able to identify pressure ulcers and be able to distinguish superficial pressure ulcers from moisture damage. They will be able to manage and treat the different pressure ulcers and moisture lesions using up to date research. This PUG tool can be used anywhere there is a patient or person at risk of skin damage. The audience will feel more confident in correctly classifying pressure damage. The PUG tool is not too ‘wordy’ you simply match the image to what you see on the patient and the window below the image will give you an indication of the skin damage. This should reduce the incorrect classification of skin damage and consequently avoid miss-management which could potentially cause further damage to an existing ulcer or develop a new one. This strategy will help provide a consistent approach to clinical practice complementing patient assessment and care planning. Pressure ulcers that are assessed and classified correctly can be appropriately managed and may lead to faster healing by improving the patient’s quality of life and ultimately lead to a reduction in associated costs.
Biography
Judith A Barnard is a Registered nurse of over 30 years’ experience and has been a Tissue Viability Clinical Nurse Specialist for about four and a half years. She has a passion to reduce the incidence of hospital-acquired pressure ulcers. Misclassification was proving to be problematic as she is working to help healthcare professionals overcome this problem. The idea for the Pug wheel came when a need for a more accessible tool for nurses would make it easier to assess patient’s pressure areas. By using a different perspective healthcare professionals are able to correctly classify skin damage.
E-mail: judith.barnard@nhs.net
