Wounds, Pressure Ulcers, and Skin Lesions Oh My!!

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As Physical, Occupational, and Speech therapists, we don’t typically have much experience with wounds and wound care, but we are expected to answer OASIS questions about wounds and pressure ulcers.

We are not going to go into specifics on each OASIS question regarding wounds and pressure ulcers, instead we will provide a quick review that will help in assessment and the proper answering of OASIS questions.
Lets begin with a review of pressure ulcer staging. Remember, pressure ulcers can ONLY occur over bony prominences.
                                  Stage 1: skin intact, erythema
                                  Stage 2: partial thickness skin loss, involving epidermis and/or dermis
                                  Stage 3: full thickness loss, necrosis of subcutaneous tissue, but not through fascia
                                  Stage 4: full thickness loss with extensive destruction, damage to muscle, bone, or
                                                other supporting structures

Stage 3 and 4 pressure ulcers NEVER heal, even once they are closed. Once an ulcer is scored as a 3 or 4 it will remain that same score unless it worsens. This will be important to remember while answering OASIS questions.  A wound that is not healing has signs and symptoms of infection or has not made progress towards healing with wound care interventions.

Other types of wounds that the OASIS asks about:
                                    Venous stasis ulcers: “wet” wounds, occur on medial aspect of lower extremity and ankle,
                                                          irregular margins, shallow, superficial, moderate to heavy exudate, minimal
                                                          pain
                                    Surgical wounds: considered a wound until re-epithelialization has been present for 30 days,
                                                          include pin sites, central lines, drains, orthopedic surgeries, shave/punch
                                                          biopsy, arthroscopies
                                                 - primary closure: staples, stitches, does not granulate therefore can only be newly
                                                    epithelialized or not healing
                                                 - secondary intention: incisional separation, do granulate
                                    Skin Lesions or Open Wounds: this OASIS category includes any skin conditions, non-bowel
                                                          ostomies, diabetic ulcers, cellulitis, arterial ulcers, PICC lines, IV sites,    
                                                         burns, cuts, bruises, rashes, skin tears, arterial ulcers, and  abscesses.

We hope that this little review helps you to successfully answer OASIS questions regarding a patients integumentary status. If ever in doubt, make sure to ASK someone for assistance.