Letters to the Editor

Dear Editor,

    I was a bit puzzled when I read the article: Pressure ulcer prevention and care: implementing the revised guidance to surveyors for long-term care facilities (Ostomy Wound Manage. 2005;51[4suppl]:7S–19S).

    The description of the Braden Pressure Ulcer Risk Assessment Scale scoring does not include the latest scoring definitions low risk, moderate risk, high risk, and very high risk. Dr. Braden did not change her tool; however, in 2001 she redefined the score categories and added this very high risk category (see https://www.bradenscale.com/newlevels.htm). I am curious as to why this information was not included in the article. I continued to be a bit wary when, under “Ulcer differentiation and location,” the Guidance document is discussed and the authors go on to describe venous ulcers, arterial ulcers, and diabetic foot ulcers but does not mention that the NPUAP staging definitions are for use with pressure ulcers only and that clinicians do not use this system to describe other wound types. This could be quite confusing to any new wound clinician.

    My practice is acute care-based and I do not use the CMS guidance document. It seems in this article that the authors are attempting to link the use of this tool by long-term care surveyors to what is currently known (the evidence) and practiced for individuals at risk for or who have pressure ulcers. Please enlighten me.

    Liz Lemiska, BSN, CWOCN, RN
    Middlesex Hospital
    Middletown, Conn.

Reply

    The purpose of the article is to help extended care facilities incorporate the new regulations into practice. Hence, our publication is consistent with the guidance document and the resources used to create it in order to eliminate any confusion on the part of long-term care providers. The document includes three levels of risk (similar to those described in the literature and on the main page of the website (https://www.bradenscale.com/levels.htm). Similarly, the publication describes staging for pressure ulcers only but does not include a statement that other ulcers should not be staged because the Minimum Data Set (version 2.0) still requires staging of all ulcers, regardless of etiology. This hopefully will be corrected when version 3.0 is released. In the meantime, healthcare providers in long-term care facilities must follow the guidelines. Thus, to be clinically correct and evidence-based, we did not reiterate the MDS mandate that other ulcers should be staged. At the same time, we did not want to confuse providers by describing why they should not do so — that would be a topic for an entirely different publication.

    However, we are pleased to hear that many clinicians are aware of this and not applying the NPUAP pressure ulcer staging system to other chronic wounds.

    Lia van Rijswijk, RN, MSN, CWCN
    Courtney Lyder, RN, ND, GNP, FAAN