PRE-STAGE 1: AN OBVIOUS, MORE DESCRIPTIVE, AND CLINICALLY IMPACTFUL TERM THAN "REACTIVE HYPEREMIA" or "BLANCHABLE ERYTHEMA" IN DESCRIBING THE STATE BEFORE STAGE 1 CONDITION

NPUAP Pressure Ulcer Classification System lists six different stages (1). There is an additional condition that may exist before a stage I pressure ulcer is reached.  This unhealthy skin may be known as “reactive hyperemia” or “blanchable erythema”.  The skin is red, warm and blanchable with higher than normal bloodflow.  The term, , “Pre-Stage I” skin that has been used previously is arguably more appropriate to use to describe this condition.(2)(3)(4)(5).

A new skin/wound assessment tool has been developed to assist non-expert clinicians in staging, and this term Pre-Stage I seems more appropriate for use as part of the tool. 

Method:

19 Nurses and 11 CNAs in a 30 bed hospital rehabilitation unit (non-expert group), were asked which term best leads to an intervention such as patient turning and offloading? 

Reactive Hyperemia, Pre-Stage I, Blanchable  Erythema

Results: 

90% of those surveyed felt that the term “Pre-Stage I” would result in preventative action.

When only the concept of “reactive hyperemia” and “blanchable erythema” were taught to the same group it was noted that minimal interventions for prevention were observable in practice.  In contrast, when the concept of Pre-Stage I was taught,  increased early interventions were more prevalent. 

Conclusion:

Pre-Stage I is a meaningful term to describe a skin condition that is caused by pressure.  In a 30 bed rehab unit, the term and concept of a Pre-Stage I as a diagnosable pre-condition prior to the development of a stage I pressure ulcer triggered increased practice of valuable early intervention such as offloading and patient turning.  Pre-Stage I is arguably a more effective term for use in a new skin and wound assessment tool that has now been designed to assist non expert bedside nurses in making skin and wound assessment.