To Stage or Not to Stage?

Do we Speak the Same Language: To Stage of Not to Stage?

Introduction

Pressure injuries (PI) must be reported accurately for coding and quality ranking and reimbursement. The training for our nurses comes from mandatory modules and the NDNQI pressure ulcer training which was developed to improve the accuracy of staging being completed by nursing. Is this really enough training to allow nursing to stage and did they all speak the same language?

Problem

Accurate identification of pressure injuries vs wounds is imperative to coding, billing and quality reporting. When reviewing cases of hospital acquired pressure injuries we saw a frequent discrepancy in the language used in charting. We believed that we were over reporting our HAPI because of nursings lack of education and experience causing incorrect language.

Method

A report was run daily to show the pressure injuries both hospital and community acquired to review the language, location and description that was being entered into the medical record. Chart reviews were completed on patients with questionable language. The coccyx, sacrum and buttocks were often used incorrectly and it did show there were more injuries that we actually had.

Results

Chart reviews clearly showed that more education was needed for nursing. In an effort to fix the problem quickly we now ask the nurses only to describe what they see on the patient and consult a WOC for accurate staging. The immediate results was a reduction of pressure injuries.

Discussion

The decision not to allow nurses to stage was met with mixed feelings. Many senior nurses felt that we were taking away their autonomy. Newer nurses with less experience felt relieved. The result was a significant decline in HAPI and therefore staging will remain in the hands of the experts proper education can be provided.