PUSH Tool Information and Registration Form

Tool Development

The Pressure Ulcer Scale for Healing (PUSH Tool) was developed by the National Pressure Ulcer Advisory Panel (NPUAP) as a quick, reliable tool to monitor the change in pressure ulcer status over time. The tool is based on (1) an analysis of research literature to identify the critical parameters commonly used to monitor pressure ulcer healing and (2) a statistical analysis (i.e. principal component analysis) of existing research data bases on pressure ulcer monitoring and (3) a national retrospective validation study. The first draft of the tool was presented at the Fifth National NPUAP Conference in February 1997. Proceedings of the conference were published in Advances in Wound Care, Vol. 10, No. 5, September 1997. Copies of the proceedings can be obtained through Springhouse Corporation (215-646-8700 or http://www.woundcarenet.com).

Further Research and Validation

Since its initial development, the tool has been validated by 2 multi-site retrospective studies and a pilot test conducted by CMS. PUSH is a research-validated tool that quickly and reliably captures the key assessments necessary to monitor whether a pressure ulcer is getting better or worse over time.

Copyright Restrictions

Noncommercial Use

Although the PUSH Tool is copyrighted to the NPUAP, you are free to use it for education, research, and practice purposes. Non-commercial users are only required to acknowledge the NPUAP and the “Version Number” of the tool on any hard-copy or electronic reproduction. We invite you to complete the PUSH User Registration Form below. This will help us monitor use of the PUSH Tool and better address the needs of PUSH Tool Users.

This a research-validated tool. Therefore, we recommend that the content of the tool not be altered or modified by individual users. If you chose to modify the tool, please note that you have made modifications after citing the NPUAP as the original source.

Commercial Use

The PUSH Tool should not be used as part of any “for profit” commercial venture or enterprise without written permission of the NPUAP. Royalties may be required under these circumstances. (Use of the PUSH Tool in the care of patients in “for profit” health care facilities is exempt from this restriction.)

PUSH Tool Use

Version 3.0 of the PUSH Tool is attached. Clinical users indicate that it is readily adopted and easy to use. Using a pocket calculator will facilitate accurate length x width calculations.

The NPUAP recommends use of the PUSH Tool at “regular intervals”. The AHCPR Treatment Guideline recommends assessments be performed “at least weekly” and “if the condition of the patient or of the wound deteriorates”. The PRESSURE ULCER HEALING CHART (which is attached to the PUSH Tool) will allow you to graph PUSH Tool scores over time for each ulcer. You should be able to “tell at a glance” whether the ulcer is healing, remains unchanged, or is deteriorating.

The PUSH Tool is designed to monitor the three critical parameters that are the most indicative of healing. In developing specific treatment plans, you will need to assess additional parameters (e.g., foul odor, color of exudate, undermining, and tunneling). Any increase in the PUSH Tool score (indicating wound deterioration) requires a more complete assessment of the ulcer and the patient’s overall condition.

If you have any questions regarding use of the PUSH Tool, please contact the NPUAP at 202-521-6789 or E-mail: npuap@npuap.org

Staff Education

When introducing any new assessment tool, staff should be educated regarding appropriate use of the tool through formal education programs. We recommend demonstrating use of the tool on actual patients and conducting interrater reliability checks (i.e. comparing assessments made by experienced and new users).

Research-based Refinements

Refinements may be made in the PUSH Tool based on the results of ongoing research. Any tool modifications will be posted at the NPUAP Web site (http://www.npuap.org) and revised copies will be sent to registered PUSH Tool Users (See registration form below).

User Evaluation and Refinement

To be an effective measure of pressure ulcer healing, the PUSH Tool must be (1) valid, (2) reliable, (3) responsive to changes in the ulcer over time, and (4) clinically practical. Please help us evaluate how well the PUSH Tool meets these criteria. The NPUAP invites and welcomes suggestions for refining and improving the PUSH Tool. Please send written comments to the NPUAP.

Send comments to:

1025 Thomas Jefferson Street, NW
Suite 500 East
Washington, DC 20007
P: 202-521-6789
F: 202-833-3636
E: npuap@npuap.org

PUSH Tool User Registration Form

Yes, I plan to use the PUSH Tool and agree to abide by the copyright restrictions as noted above.


To register as a PUSH Tool User and receive tool revisions, please print the form below, fill out the information on the form, and mail to:

1025 Thomas Jefferson Street, NW
Suite 500 East
Washington, DC 20007
FAX completed form to 202-833-3636



Work Phone:_____________________________________________________

I plan to use the PUSH Tool for (check all that apply):

______Clinical Practice ______Education ______Research ______Other

I plan to use the PUSH Tool in a (check all that apply):

_____Long Term Care Facility _____Skilled Nursing Facility _____Rehabilitation Facility
_____Subacute Care Facility _____Acute Care Facility _____Ambulatory Care Setting
_____Wound Care Center _____Home Care _____Other (Please specify)

Welcome to the growing community of health care professionals using the PUSH Tool!

Reprint Agreement
Instructions for Using the PUSH Tool
PUSH Tool 3.0