When is a grade 4 pressure ulcer not grade 4?

Research paper by Shiu-Ling SL Briggs

Indexed on: 10 Nov '11Published on: 10 Nov '11Published in: British journal of nursing (Mark Allen Publishing)


The adoption of the European Pressure Ulcer Advisory Panel (EPUAP) (2009) pressure ulcer classification system within healthcare trusts in the UK has provided health professionals with a common approach for the description of tissue damage for pressure ulcers. However, the omission of the 'unstageable/unclassified' and 'suspected deep tissue injury under intact skin' has caused difficulties when the visual appearance of pressure ulcers falls outside the four grades listed in the classification system. These difficulties lead health professionals to overestimate the degree of tissue damage, resulting in confusion in regards to determining the true extent of the tissue damage and often misdirection of scarce resources (Moore, 2005). The Berkshire Tissue Viability Nurses Group attempted to bring clarity to the situation by highlighting the issues to raise awareness and stimulate discussion among health professionals. The author, with support of the Berkshire Tissue Viability Nurses Group, first presented the content of this article at a meeting of the No Needless Skin Breakdown Work Stream meeting of the South Central Strategic Health Authority Patient Safety Federation in January 2011.