Flawed and inconsistent wound documentation has serious risk-management implications. This blog post will examine some fine points regarding pressure ulcer nomenclature and documentation.
Many definitions and classification schemes for pressure ulcers were developed over the years and continue to be a source of confusion. As patients move across the healthcare continuum from hospital to rehabilitation facility to nursing home, descriptive data can vary greatly even if the wound stays the same. In the face of an evolving wound the confusion from inconsistent or inaccurate documentation can escalate further.
The term decubitus ulcer, or more simply, decubitus (pleural decubiti), was the standard for medical terminology in the 19th and early 20th centuries. Jean-Martin Charcot, an eminent European physician who studied the physiology of aging, used the term decubitus. The death certificate of the first patient with memory disorder described by Dr. Alois Alzheimer states that she died from “septicaemia due to decubitus.”
The term decubitus is is derived from the Latin verb “decumbere” which translates as “lying down.” This name has become obsolete as experts agree that you don’t need to be lying down to get a pressure ulcer. For example, pressure ulcers can occur on the neck under a cervical collar, behind the ear beneath oxygen tubing, or on the leg under a cast.
The term pressure ulcer became the documentation standard only in the past two decades with National Pressure Ulcer Advisory Panel (NPUAP) guidelines, and the US National Library of Medicine’s controlled vocabulary used for indexing articles in MEDLINE and PubMed. The term pressure sore is synonymous with pressure ulcer but the latter is preferred due to the standards set by NPUAP and the National Library of Medicine.
The term bedsore is common lay usage synonymous with pressure ulcer, which can also be found as “bed-sore” and “bed sore.” This label is not generally acceptable in current medical documentation and terminology, however a century ago it was standard nomenclature for healthcare practitioners. In fact, Florence Nightingale in her classic text, Notes on Nursing, used the term bed-sore:
“…if he has a bed-sore, it is generally the fault not of the disease, but of the nursing.”
There are other sources of confusion with respect to pressure ulcer nomenclature and documentation. These include the term “stage” which has sometimes been indicated as “grade,” “category,” or “level.” Another is the use of Arabic versus Roman numerals when designating stage. Still another source of confusion is the labeling of anatomic location of wounds. These topics will be addressed in future blog posts.
* * * * * * * * * * * * * * *
See my book, Pocket Guide to Pressure Ulcers, for further information on pressure ulcer staging and documentation.
References for this post include:
Kottner et al. Pressure Ulcers: A Critical Review of Definitions and Classifications, Ostomy Wound Management 55: (9), p 22-29, 2009
Levine JM. Historical perspective on pressure ulcers: the decubitus ominosus of Jean-Martin Charcot. J Am Geriatr Soc. 2005 Jul;53(7):1248-51.