Acoustic pressure wound therapy to debride unstageable pressure ulcers in the acute care setting: a case series

As of October 1, 2008, prompt identification and accurate staging of pressure ulcers present on admission to acute care hospitals became essential for Medicare reimbursement. In short, Medicare will no longer cover the added costs associated with care of Stage III and Stage IV pressure ulcers not present on admission; such ulcers will be classified as hospital-acquired conditions that could reasonably be prevented with application of evidence-based guidelines. Unstageable pressure ulcers present a particular challenge under the new policy. According to national pressure ulcer guidelines, until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. The authors describe the first three patients (a 61-year-old woman and 52-year-old and 89-year-old men, all with different comorbidities and ulcer locations) to receive acoustic pressure wound therapy (APWT) for rapid debridement of unstageable pressure ulcers at their acute care hospital. Within 2 days, ulcers that had been completely covered with slough and/or eschar were cleared enough to be accurately identified as Stage III or Stage IV. Rapid and efficient debridement maximized reimbursement potential for the additional costs associated with these advanced-stage pressure ulcers.