Teaching the "Fruits" of Pressure Ulcer Assessment

Recent changes in payment for preventable diagnoses require facilities to identify and document any pressure ulcers (PU) present on admission (POA).  “Physician/provider determination and documentation during the hospitalization that the pressure ulcer was present at the time of admission is critical ...  [however], the expertise of wound assessment in hospitals is predominantly within nursing. Competence of the provider in assessment is critical”.¹

Floor staff must have sufficient knowledge to appropriately stage pressure ulcers.  Evidence-based practice indicates that “educational materials should be prepared and tailored to deliver the appropriate messages; … of special concern is that training efforts be timely, targeted and tactical”. ¹

With the demands of floor nursing, it is essential that the PU training be memorable.  “Simply put, using association to improve memory means associating a familiar object to the unfamiliar in some ridiculous fashion; creating meaning where no meaning previously existed.”²

Linking PUs to food objects is a unique way to understand and remember.

Category/Stage	Description	Liken to the food item
Stage One: “THINK TOMATO	“Intact skin with non-blanchable redness”.3	Tomato doesn’t blanch with application of pressure.
Stage Two: “THINK POTATO”	“Partial thickness loss of dermis presenting as a shallow open ulcer”.3	Potato peeler used to demonstrate superficial epidermal loss.
Stage Three: “THINK APPLE”	“Full thickness tissue loss. Subcutaneous visible but bone, tendon or muscles are not exposed”.3	Small bite taken- no core showing, simulates SQ tissue.
Stage Four:  “THINK PEACH”	Full thickness tissue loss, exposed bone, tendon or muscles”.3	Large bite taken, pit visible, represents muscle/bone.
Unstageable: “THINK ROTTEN PEACH”	“Full thickness tissues loss… base of the ulcer is covered by slough and/or eschar”.3	Base not visible, unknown depth of tissue damage.
DTI: “THINK EGGPLANT”	“Purple or maroon localized area of discolored intact skin”.3	Eggplant skin is intact, but not appropriate color for people!