Improving Skin Ulcer Documentation by Eliminating the Numerical Classification System and Documenting the Partial Thickness and Full Thickness Depth

It is often the bedside nurse that performs the patient’s first skin inspection.  Most health care institutions use the numerical classification system (Pressure Ulcer Stages) to identify its patient’s skin ulcerations.  The pressure ulcer stages are often misinterpreted or misused in the clinical setting (Sibbald, 2011).  A rapid improvement initiative was implemented at a 284 bed acute care hospital to measure the improvement in the documentation and identification of wounds/ulcers of the patients admitted by eliminating the use of the numerical classification system currently being used, and using the partial thickness and full thickness depth.  The ulcer documentation of eleven patients was reviewed and there was 67.7% inaccurate and inconsistent documentation.  After ninety days of implementing the use of the partial or full thickness depth system, the documentation of eleven patients was reviewed.  There was an improvement of ulcer identification and documentation consistency by 28.4%.  Currently, there is not a consensus in the research regarding the best method to improve the accuracy in identification and documentation of skin ulcers.  However, the improvement shown with the use of the partial and full thickness ulceration labels has shown that there is great potential to improve not only the care of the patient with a skin ulcer, but also to improve the financial reimbursement of the healthcare institution.  The rapid improvement initiative undertaken by the nursing staff has impacted the nursing care not only at its site, but also that of a corporate level.  The use of partial and full thickness ulceration documentation will be implemented throughout the hospital system in 2015.