NPUAP responds to the National Quality Forum plans to report all hospital acquired pressure injuries
Tuesday, September 3, 2019
The National Quality Forum (NQF) has recommended that Measure #3498e “Hospital Harm: Pressure Injury” be revised to include Stage 2 pressure injuries. As an e-measure, data would be abstracted from the Electronic Health Record (EHR).
NPUAP supports the concept of pressure injury as a quality measure, but has raised the following concerns regarding the inclusion of Stage 2 as currently proposed:
Stage 2 pressure injuries are often confused with other types of partial thickness wounds. More training and education of bedside care providers is necessary to ensure accurate documentation in the EHR. While Stage 2 pressure injuries differ from other partial thickness wounds such as those characterized as moisture associated skin damage (MASD) (including incontinence associated dermatitis [IAD] and intertriginous dermatitis [ITD]), medical adhesive related skin injury (MARSI), or traumatic wounds (skin tears, burns, abrasions); it is not uncommon for wounds with the above etiologies to be erroneously identified as Stage 2 pressure injuries. The presence of a wound care clinician can improve accuracy; however, they are not available in all settings. Education of bedside providers from all disciplines is critical to improve accuracy in medical record documentation for all pressure injuries.
Stage 2 pressure injuries carry a less serious burden in terms of patient harm. If reported, Stage 2 should be reported separately and be associated with less serious penalties. Stage 2 pressure injuries carry a less serious burden in terms of patient harm than Stage 3, Stage 4, Unstageable, and Deep Tissue Pressure Injuries (DTPI). Partial thickness wounds heal primarily as a result of epidermal regeneration and often heal without untoward consequences, loss of skin function or scar tissue formation. Based on the healing capabilities inherent in these partial thickness wounds, it is the expert opinion of the NPUAP that the presentation of a Stage 2 pressure injuries does not carry the same potential longstanding negative consequences to patients as do full thickness pressure injuries. Stage 2 pressure injuries constitute a very real patient harm that should be monitored and addressed; however, the relative level of harm is less than with Stage 3, Stage 4, Unstageable pressure injuries and potentially DTPI. A clinical analogy to this would be patient falls. While all patient falls are a serious adverse event, all falls are not penalized, as many falls result in no adverse effects or minimal adverse patient effects.
Click HERE to view the full NPUAP response to the proposed NQF Measure 3498e.