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
James B. Lutz, MS, CCRA
,
Lutz Consulting LLC, Medical Writing Services, Buellton, CA
Oscar Alvarez, PhD, CCT, FAPWCA
,
Calvary Hospital, Director, Wound Care Program, Bronx, NY
Elizabeth A. Ayello, PhD, RN, ACNS-BC, FAPWCA, FAAN
,
Excelsior College School of Nursing, Clinical Associate Editor, Advances in Skin and Wound Care, New York, NY
Sharon Baranoski, MSN, RN, CWOCN, 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, CETNCS
,
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 Lou kennedy-Evens, RN, CS, FNP
,
KL Kennedy, LLC, Consultant, 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
Cynthia J. Sylvia, MSc, MA, RN, CWOCN
,
Gaymar Industries, Inc., Program Manager, Educational Development, Charles Town, WV
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 the end stages of life, any of a number of vital body systems can, and often do, 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 have established an expert group to build a consensus proposal on SCALE. The panel consisted of 18 internationally recognized key opinion leaders including clinicians, caregivers, medical researchers, legal experts, academicians 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.
General agreement existed that, like any other organ of the body, the skin is subject to a loss of integrity due to internal and external insults. Contrary to popular myth, not all pressure ulcers are avoidable. Our current understanding of the complex skin changes that can occur at life’s end (including the KTU) is limited, and additional research and expert consensus is necessary. Specific areas requiring research and consensus include: 1) assessing the critical etiological factors of SCALE, 2) clinically describing and diagnosing the conditions, and 3) recommending appropriate pathways of care. The panel concluded with a series of proposed consensus statements to which public comment was sought. This poster will present these statements and the panel’s overall findings.
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