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Background: Accurate identification of suspected deep tissue injury pressure ulcers is imperative for proper coding, regulatory reporting and timely, evidence-based appropriate intervention. At our facility, a large metropolitan academic medical center, identification of the different etiologies of skin discoloration differential, particularly purple and/or maroon coloration, was identified as confusing to the nursing staff, especially in patients with darker skin tones. Nursing staff frequently referred all noted purple and/or maroon discoloration to the WOC nursing service. Uncertainty in identification by the bedside nurse prompted unnecessary referrals thereby increasing healthcare dollars, slowing nursing work flow, and verbalized frustration by the nursing staff. Additionally, nursing staff duplicated efforts by involving skin care nurse champions to assist in the identification and accurate documentation of many purple/maroon skin discolorations even after WOC nursing service evaluation. This issue prompted the need for the WOC nursing service to review the literature for comparison of different skin discoloration etiologies, develop, and present an educational intervention.
Method: A quick-reference guide and educational tool for bedside staff use was developed to assist in accurate identification, documentation, and appropriate treatment/interventions. This guide included a pictorial grid with definitions, etiology and treatment options for accurate documentation and treatment choices.
Outcomes: Improved etiology descriptions by staff of skin discolorations as seen through electronic medical record documentation and notification to the WOC nursing service. Additionally, there is a decrease in inappropriate referrals to the WOC nursing service concerning purple skin discoloration not related to pressure damage.