Policy implications of using reverse staging to monitor pressure ulcer status.

In 1995, the National Pressure Ulcer Advisory Panel held its Fourth National Conference, "Pressure Ulcer Healing: Controversy to Consensus, Assessment Methods and Outcomes." At that time, agreement was reached on uses and misuses of the current pressure ulcer staging system. Participants agreed that pressure ulcer staging definitions should not be used in reverse order to measure improvement in an ulcer. Negative outcomes of reverse staging were seen as (1) denial of acute or skilled care after Stage IV ulcers were restaged as Stage II ulcers; (2) withdrawal of pressure-reducing support surfaces when ulcers "healed" from Stage III or Stage IV to Stage II; and (3) lower fees paid to extended-care facilities for care of patients with healing Stage III and Stage IV ulcers that were reclassified as Stage II or Stage I pressure ulcers.