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4414 Skin Changes at Life's End (SCALE)

R. Gary Sibbald, BSc, MD, FRCPC, (Med, Derm), MACP, DABD, MEd, FAPWCA , University of Toronto, Director of Medical Education & Wound Healing Clinic, Toronto, ON, Canada
Diane L. Krasner, PhD, RN, CWCN, BCLNC, FAAN , **, Wound & Skin Care Consultant, York, PA
James B. Lutz, MS, CCRA , Lutz Consulting LLC, Medical Writing Services, Buellton, CA
Cynthia J. Sylvia, MSc, MA, RN, CWOCN , Gaymar Industries, Inc., Program Manager, Educational Development, Charles Town, WV
Oscar Alvarez, PhD, CCT, FAPWCA , Calvary Hospital, Director, Wound Care Program, Bronx, NY
Elizabeth A. Ayello, PhD, RN, ACNS-BC, APWCA, FAAN , Excelsior College School of Nursing, Clinical Associate Editor, Advances in Skin and Wound Care, New York, NY
Sharon Baranoski, MSN, RN, CWCN, APN, DAPWCA, FAAN , Wound Care Dynamics, Inc. Consultant Services, President, Shorewood, IL
William J. Ennis, DO, MBA, FACOS , University of Illinois, Professor of Surgery, Palos Heights, IL
Nancy Ann Faller, RN, MSN, PhD, ETN , None, Consultant, Carlisle, PA
Jane Hall , Huie, Fernambucq & Stewart, LLP, Malpractice Defense Attorney, Birmingham, AL
Rick E. Hall, BA, RN, CWCN , Helping Hands Wound Care, Wound Care Nurse, Wichita, KS
Karen Kennedy-Evans, RN, CS, FNP , K.L.Kennedy, LLC, Wound and Skin Management, Tucson, AZ
Diane Langemo, PhD, RN, FAAN , Langemo & Assoc., Adjunct Faculty of U of ND College of Nursing, Grand Forks, ND
Joy E. Schank, RN, MSN, ANP, CWOCN , Schank Companies, Private Practice, Himrod, NY
Thomas P. Stewart, PhD , Gaymar Industries, Inc., Present, Orchard Park, NY
Nancy A. Stotts, RN, EdD, FAAN , University of California, San Francisco, Professor, San Francisco, CA
David R. Thomas, MD, FACP, AGSF, GSAF, CMD , St. Louis University, Professor of Medicine, St. Louis, MO
Dorothy Weir, RN, CWON, CWS , Osceola Regional Medical Center, Director Wound Healing Center, Kissimmee, FL
It is well accepted that during end stages of life, any of a number of vital body systems can shut down to varying degrees. The result of organ shut down can be devastating, resulting in injury or interference with functioning of other systems that may eventually lead to death. We propose that the skin, the largest organ of the body, is no different, and also can become dysfunctional to varying degrees and with varying levels of resultant injury. When this dysfunctional state occurs, the manifestations are termed, Skin Changes At Life’s End (SCALE).

We established an expert group to build a consensus on SCALE. The panel consists of 18 internationally recognized key opinion leaders including clinicians, caregivers, medical researchers, legal experts, academicians, a medical writer, and leaders of professional organizations. A forum was held on April 4-6, 2008 in Chicago, IL, to discuss the nature of SCALE, including the Kennedy Terminal Ulcer (KTU) and other end of life skin changes. The final consensus statements were edited by the panel, and further reviewed by 49 international distinguished reviewers. A modified Delphi process was used to determine the final statements and 52 international distinguished reviewers reached consensus on the final statements.The panel concluded that: 1) our current comprehension of SCALE is limited; 2) the SCALE process is insidious and difficult to prospectively determine; 3) additional research and expert consensus is necessary; and 4) contrary to popular myth, not all pressure ulcers are avoidable.

Specific areas requiring research and consensus include identification of etiological and pathophysiological factors involved in SCALE, clinical and diagnostic criteria for describing SCALE, and recommendations for evidence-informed pathways of care.

The panel produced a final consensus document consisting of 10 statements which is available for public dissemination. This poster will present these statements and the panel’s overall findings.

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