Indicator Number

Definition

All

Pressure Ulcer – A localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear.

Health Care Acquired - An incident which occurred during NHS funded care (this includes hospital and outside hospital).

Hospital - This includes where a patient receives NHS funded care in secondary care or community hospitals.

Outside hospital - This includes where a patient receives NHS funded care outside of a hospital setting e.g. where patients receive NHS funded care in their own home from community nurses and in nursing homes where Health Boards have commissioned the care.

1 - Number of instances of healthcare acquired Category 1 pressure ulcers developed in the reporting month

Category 1 Pressure Ulcer - Non-blanchable erythema.

Intact skin with non-blanchable redness of a localized area over a bony prominence.  Darkly pigmented skin may not have visible blanching; its colour may differ from the surrounding area.  The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue.

2 - Number of instances of healthcare acquired Category 2 pressure ulcers developed in the reporting month

Category 2 Pressure Ulcer - Partial thickness skin loss. 

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough.  Also presents as an intact or open/ruptured serum-filled blister.  Presents as a shiny or dry shallow ulcer without slough or bruising.* This category should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.

*Bruising indicates suspected deep tissue injury.

3 - Number of instances of healthcare acquired Category 3 pressure ulcers developed in the reporting month

Category 3 Pressure Ulcer - Full thickness skin loss. 

Full thickness tissue loss.  Subcutaneous fat may be visible but bone, tendon or muscle are not.  Slough may be present but does not obscure the depth of tissue loss.  May include undermining and tunnelling.  The depth of a category 3 pressure ulcer varies by anatomical location.  The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and category 3 ulcers can be shallow.  In contrast, areas of significant adiposity can develop extremely deep category 3 pressure ulcers.

4 - Number of instances of healthcare acquired Category 4 pressure ulcers developed in the reporting month

Category 4 Pressure Ulcer - Full thickness tissue loss. 

Full thickness tissue loss with exposed bone, tendon or muscle.  Slough or eschar may be present on some parts of the wound bed.  Often include undermining and tunnelling.  The depth of a category 4 pressure ulcer varies by anatomical location.  The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow.  Osteomyelitis possible.

5 - Number of instances of healthcare acquired unstageable pressure ulcers developed in the reporting month

Unstageable Pressure Ulcer - Depth unknown. 

Obscured full-thickness skin and tissue loss.  Full thickness and issue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.  If slough or eschar is removed, a category 3 or category 4 pressure injury will be revealed.  Stable eschar (dry, intact) on the heel or ischemic limb should not be softened or removed.

6 - Number of instances of healthcare acquired suspected deep tissue injury developed in the reporting month

Suspected Deep Tissue Injury - Depth unknown. 

Purple or maroon localised area of discoloured intact skin or blood filled blister due to damage of underlying soft tissue from pressure and/or shear.  The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.  Deep tissue injury may be difficult to detect in individuals with dark skin tones.  Evolution may include a thin blister over a dark wound bed; the wound may further evolve and become covered with thin eschar.

7 - Total number of instances of healthcare acquired pressure ulcers developed in the reporting month

Automatically calculates a total of Indicators 1 to 6.