PUSH Tool 3.0

Patient Name:________________________________________ Patient ID#:_______________

Ulcer Location: _______________________________________ Date:_____________________

DIRECTIONS:
Observe and measure the pressure ulcer. Categorize the ulcer with respect to surface area, exudate, and type of wound tissue. Record a sub-score for each of these ulcer characteristics. Add the sub-scores to obtain the total score. A comparison of total scores measured over time provides an indication of the improvement or deterioration in pressure ulcer healing.

Length x Width:  Measure the greatest length (head to toe) and the greatest width (side to side) using a centimeter ruler.  Multiply these two measurements (length x width) to obtain an estimate of surface area in square centimeters (cm2). Caveat: Do not guess!  Always use a centimeter ruler and always use the same method each time the ulcer is measured.

Exudate Amount:  Estimate the amount of exudate (drainage) present after removal of the dressing and before applying any topical agent to the ulcer. Estimate the exudate (drainage) as none, light, moderate, or heavy.

Tissue Type: This refers to the types of tissue that are present in the wound (ulcer) bed.  Score as a "4" if there is any necrotic tissue present.  Score as a "3" if there is any amount of slough present and necrotic tissue is absent.  Score as a "2" if the wound is clean and contains granulation tissue. A superficial wound that is reepithelializing is scored as a "1". When the wound is closed, score as a "0".

4 - Necrotic Tissue (Eschar): black, brown, or tan  tissue that adheres firmly to the wound bed or ulcer edges and may be either firmer or softer than surrounding skin.
3 - Slough: yellow or white tissue that adheres to the ulcer bed in strings or thick clumps, or is mucinous.
2 - Granulation Tissue: pink or beefy red tissue with a shiny, moist, granular appearance.
1 - Epithelial Tissue: for superficial ulcers, new pink or shiny tissue (skin) that grows in from the edges or as islands on the ulcer surface.
0 - Closed/Resurfaced: the wound is completely covered with epithelium (new skin).

Version 3.0: 9/15/98

©National Pressure Ulcer Advisory Panel

PRESSURE ULCER HEALING CHART
(To Monitor Trends in PUSH Scores Over Time)
(use a separate page for each pressure ulcer)

Patient Name:_________________________________________ Patient ID#:______________

Ulcer Location: _______________________________________ Date:____________________
 

Directions: Observe and measure pressure ulcers at regular intervals using the PUSH Tool. Date and record PUSH Sub-scale and Total Scores on the Pressure Ulcer Healing Record below.

Graph the PUSH Total Score on the Pressure Ulcer Healing Graph below.

 PUSH Tool Version 3.0: 9/15/98

Instructions for Using the PUSH Tool

To use the PUSH Tool, the pressure ulcer is assessed and scored on the three elements in the tool:

•Length x Width --> scored from 0 to 10
•Exudate Amount ---> scored from 0 (none) to 3 (heavy)
•Tissue Type ---> scored from 0 (closed) to 4 (necrotic tissue)

In order to insure consistency in applying the tool to monitor wound healing, definitions for each element are supplied at the bottom of the tool.

Step 1: Using the definition for length x width, a centimeter ruler measurement is made of the greatest head to toe diameter. A second measurement is made of the greatest width (left to right). Multiple these two measurements to get square centimeters and then select the corresponding category for size on the scale and record the score.

Step 2: Estimate the amount of exudate after removal of the dressing and before applying any topical agents. Select the corresponding category for amount & record the score.

Step 3: Identify the type of tissue. Note: if there is ANY necrotic tissue, it is scored a 4. Or, if there is ANY slough, it is scored a 3, even though most of the wound is covered with granulation tissue.

Step 4: Sum the scores on the three elements of the tool to derive a total PUSH Score.

Step 5: Transfer the total score to the Pressure Ulcer Healing Graph. Changes in the score over time provide an indication of the changing status of the ulcer. If the score goes down, the wound is healing. If it gets larger, the wound is deteriorating.

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