A temporary solution to reverse staging: the skin care evaluation sheet

The National Pressure Ulcer Advisory Panel (NPUAP) has published recommendations over the last several years against the use of reverse staging to describe the healing of a pressure ulcer. Clinical studies have shown that as Stage IV pressure ulcers heal to more shallow depths, they do not replace lost muscle, subcutaneous fat, and dermis before they re-epithelialize. Instead the defect is filled with granulation tissue composed of endothelial cells, fibroblasts, collagen, and an extracellular matrix. The Minimum Data Set-2 (MDS-2) is a comprehensive assessment tool required to be completed on a quarterly basis in all long term care facilities that provide care to Medicare patients. Section M of the MDS-2 addresses skin condition and requires that pressure ulcers be staged as assessed within seven days of documentation, using the guidelines in that section. No mechanism currently exists to document progression of ulcer healing, leaving the practitioner no alternative but to restage the ulcer. This article presents one facility's effort to acknowledge the NPUAP recommendations, while complying with reimbursement screening methods.