Teaching the Non-Expert to Stage Pressure Injuries

Introduction: 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; Doctors, Physician Assistants, Nurse Practitioners, Nurses, and Therapists who do not receive additional training in wound care have difficulty accurately staging PI using the definitions noted within the guidelines by The National Pressure Injury Advisory Panel.

Background: In our agency, the staging inaccuracies of PIs were identified on chart review (example: A PI with slough identified as a STAGE 2 PI, another example: a referral for care from a provider asking for an evaluation of a STAGE 3 venous ulcer). To determine staff competency in identifying and staging PI, a test was developed with photographs and a description of 33 PI and wounds. The test was administered to the staff (Registered Nurses, Licensed Vocational Nurses, Physical Therapists, and Occupational Therapists). The test has been administered to all staff hired over the last 4-years (a total of 248 staff were tested). This initial and ongoing testing continues to show that 10% of the staff can stage and identify PI correctly 80% of the time (mean score < 60%).

Method: To teach staff how to stage and identify PIs correctly; an algorithm was developed. The algorithm asks a series of questions “guiding” staff to the correct staging of PIs. Staff instruction included a review of PI identification and staging. The staff was instructed on how to utilize the algorithm in identifying the stages of PI. Staff is then re-tested two days later (after instruction period) using a different PI test. Test scores on average increased 19% (mean score > 80%).

Results/Conclusion: PI stage identification is a required annual competency at our agency. Currently (2021 testing results), > 80% of staff are able to identify 80% of PIs correctly when tested (mean score, > 90%). Accurate PI identification remains an issue with the non-specialized Health Care Provider as shown by test results of staff hired into the agency. Utilizing the algorithm tool can increase the Health Care Professional competency in Pressure Injury Identification.