The staging system is one way of summarizing certain characteristics of pressure ulcers, including the extent of tissue damage. The best definitions for the stages of pressure ulcers are from the National Pressure Ulcer Advisory Panel. You will find much more information about Pressure Ulcers at their website. Nursing home and hospital surveyors will use this staging system as they look at pressure sores during a survey.

Stage I is a change in normal intact skin. The change can be seen and is a result of pressure on the skin. Some of the changed signs are: skin temperature (warmth or coolness); tissue consistency (firm or boggy); Sensation (pain, itching); and/or a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues. Many times Stage I pressure ulcers may be difficult to identify because they are not readily visible and they present with greater variability. Advanced technology (not commonly available in nursing homes) has shown that a Stage I pressure ulcer may have minimal to substantial tissue damage in layers beneath the skin’s surface, even when there is no visible surface penetration. The Stage I will generally persist even after the pressure on the area has been removed for 30-45 minutes.

In Stage II part of the skin is lost. The ulcer is superficial and looks like an abrasion, blister, or shallow crater.

In Stage III there is skin loss involving damage to subcutaneous tissue that may extend down to, but not through, underlying tissues covering the muscle. It looks like a deep crater.

A Stage IV has extensive skin loss with destruction and/or tissue necrosis (dead tissue), or damage to muscle, and bone.

Although it may be difficult, it is important that you, as well as the nursing home and hospital surveyors, know about these stages and that you help to monitor your loved one for signs of a pressure ulcer. Prevention is the best thing, but if your loved one develops a pressure ulcer whether in a hospital, nursing home, or at home, check out the information available on the Internet and learn all you can about Pressure Ulcers. Learn what acceptable treatments there are, and then question the staff as to what treatment is being provided to your loved one. Ask questions and be proactive. In addition, report it to the local licensing and certification agency so an investigation can be conducted by a nursing home and hospital surveyor.

Be safe and be informed!


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