Ask the treatment expert ... about identifying pressure ulcers

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Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC

How do you deal with the age-old question “Is it a pressure ulcer or not?”

Many healthcare professionals are frequently faced with the dilemma of how to document a reddened area on the buttocks, peri-rectal area or perineal area. Is this a pressure ulcer or is the underlying etiology totally different? 

Before determining the actual nature of this condition, first think of the definition of a pressure ulcer proposed by the National Pressure Ulcer Advisory Panel: “A pressure ulcer is an area of localized skin injury and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear.” Therefore, if the reddened area is not over a bony prominence and if the provider feels that pressure is not involved, the damaged tissue may not be a pressure ulcer and additional investigation and interventions are necessary.

If the skin is intact but erythema is noted, the clinician should check for blanching. If the area blanched, this is not a pressure ulcer. The next step would be to determine if the patient has bladder and/or bowel incontinence. This is a clue that this might not be a pressure ulcer. If the area is given a stage, it represents that it is a pressure ulcer, which can lead to both government sanctions and litigation.

If there is no pressure and the erythema blanches, the disruption of the skin could be due to incontinence. This was recognized by an international group at a 2005 consensus conference as the skin condition “Incontinence-Associated Dermatitis” (IAD). 

IAD is located in the perineum, perianal area, the inner thighs, and/or buttocks. These wounds range from blanchable erythema to partial thickness ulcers. Areas have irregular, indistinct borders and appear as macerated wounds. 

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